PECARN — Head trauma
Two age branches of the paediatric algorithm after minor blunt head trauma.
PECARN — <2 years
Principle
CT decision aid after minor blunt paediatric head trauma: suggested algorithm in Figure 3 of the original PECARN 2009 text, without numeric probability or diagnosis.
Scope
Blunt head trauma <24h, GCS14–15, child <2 years. Do not extrapolate to penetrating trauma, bleeding disorder, ventricular shunt, brain tumour, neurological condition complicating examination or prior imaging. Trivial trauma with no symptom beyond abrasion/laceration excluded from the study. Increased caution before 3 months; suspected abuse and deterioration need their own assessment. No individual risk percentage or automatic decision.
Interpretation limits
Blunt head trauma <24h, GCS14–15, child <2 years. Do not extrapolate to penetrating trauma, bleeding disorder, ventricular shunt, brain tumour, neurological condition complicating examination or prior imaging. Trivial trauma with no symptom beyond abrasion/laceration excluded from the study. Increased caution before 3 months; suspected abuse and deterioration need their own assessment. No individual risk percentage or automatic decision.
Formula and logic
Priority1: GCS14 OR altered mental status OR skull fracture → CT branch. Otherwise, at least one intermediate criterion → observation/CT. No criterion → CT-not-recommended branch. No sum of points.
Interpretation
- CT not recommended by the algorithm
- All assessed criteria are absent (GCS15). The rule does not replace observation or clinical judgement.
- Discuss observation or CT
- Choice depends on isolated or multiple signs, course, clinician experience and parental preference. Age<3 months: increased caution.
- CT recommended by the algorithm
- GCS14, another sign of altered mental status or a skull fracture sign. Urgent clinical assessment; no diagnosis inferred.
Definition version : 0.1.0
Sources
- Kuppermann et al. · PECARN — Identification of children at very low risk of clinically-important brain injuries after head trauma
2009-10-03 · Original text deposited by PECARN: methods pp 1161–1163, figures 2–3 pp 1167–1168 and discussion1169; <2/≥2-year branches, GCS14–15, criteria, mechanisms and exclusions read on 6 October2026. DOI10.1016/S0140-6736(09)61558-0. Figure 3 visually reread; no image or probability copied.
PECARN — 2–17 years
Principle
CT decision aid after minor blunt paediatric head trauma: suggested algorithm in Figure 3 of the original PECARN 2009 text, without numeric probability or diagnosis.
Scope
Blunt head trauma <24h, GCS14–15, child aged2 to17 years. Do not extrapolate to penetrating trauma, bleeding disorder, ventricular shunt, brain tumour, neurological condition complicating examination or prior imaging. Trivial trauma with no symptom beyond abrasion/laceration excluded from the study. Suspected abuse and deterioration need their own assessment. No individual risk percentage or automatic decision.
Interpretation limits
Blunt head trauma <24h, GCS14–15, child aged2 to17 years. Do not extrapolate to penetrating trauma, bleeding disorder, ventricular shunt, brain tumour, neurological condition complicating examination or prior imaging. Trivial trauma with no symptom beyond abrasion/laceration excluded from the study. Suspected abuse and deterioration need their own assessment. No individual risk percentage or automatic decision.
Formula and logic
Priority1: GCS14 OR altered mental status OR skull fracture → CT branch. Otherwise, at least one intermediate criterion → observation/CT. No criterion → CT-not-recommended branch. No sum of points.
Interpretation
- CT not recommended by the algorithm
- All assessed criteria are absent (GCS15). The rule does not replace observation or clinical judgement.
- Discuss observation or CT
- Choice depends on isolated or multiple signs, course, clinician experience and parental preference.
- CT recommended by the algorithm
- GCS14, another sign of altered mental status or a skull fracture sign. Urgent clinical assessment; no diagnosis inferred.
Definition version : 0.1.0
Sources
- Kuppermann et al. · PECARN — Identification of children at very low risk of clinically-important brain injuries after head trauma
2009-10-03 · Original text deposited by PECARN: methods pp 1161–1163, figures 2–3 pp 1167–1168 and discussion1169; <2/≥2-year branches, GCS14–15, criteria, mechanisms and exclusions read on 6 October2026. DOI10.1016/S0140-6736(09)61558-0. Figure 3 visually reread; no image or probability copied.