PECARN Pediatric Head Injury/Trauma Algorithm
Notes:
- Severe mechanism of injury: Motor vehicle crash with patient ejection, death of another passenger, or rollover; pedestrian/bicyclist without helmet struck by motorized vehicle; falls of more than 3 feet (younger than 2 years) or 5 feet (2 years and older); or head struck by high-impact object
- Altered mental status: agitation, somnolence, repetitive questioning, or slow response to verbal communication
- Signs of basilar skull fracture: hemotympanum, raccoon eyes, Battle's sign, or CSF otorrhea/rhinorrhea
About the PECARN Algorithm
The Pediatric Emergency Care Applied Research Network (PECARN) developed a clinical prediction rule to identify children at very low risk of clinically important traumatic brain injuries (ciTBI) following head trauma who do not require computed tomography (CT) scans.
Clinical Significance
The PECARN rule helps clinicians identify children with minor head trauma who are at very low risk of clinically important traumatic brain injuries, potentially reducing unnecessary CT scans and radiation exposure in the pediatric population.
When to Use
Use this algorithm for children with Glasgow Coma Scale (GCS) scores of 14-15 after head trauma. The algorithm is divided into two age groups: children younger than 2 years and children 2 years and older.
Limitations
- Not applicable to children with GCS < 14
- Not validated for penetrating trauma
- Does not apply to children with bleeding disorders, pre-existing neurological disorders, or known brain tumors
- Clinical judgment should always be used alongside this decision tool
Evidence Base
The PECARN rule was derived and validated in a large prospective cohort study of over 42,000 children with minor head trauma. It has a negative predictive value of 99.9% for clinically important traumatic brain injury in children meeting the low-risk criteria.
References
- Kuppermann N, Holmes JF, Dayan PS, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160-1170.
- Easter JS, Bakes K, Dhaliwal J, Miller M, Caruso E, Haukoos JS. Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study. Ann Emerg Med. 2014;64(2):145-152.
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