PECARN Head Trauma

Name: PECARN Head Trauma
Creator: Daniel Diaz-Gil, MD
Keywords: PECARN, head injury, traumatic brain injury, TBI, ciTBI, CT, computed tomography, head trauma, concussion, pediatric, decision rule, clinical decision, skull fracture, loss of consciousness

PECARN decision rule to identify children at very low risk of clinically important traumatic brain injury

The PECARN Head Trauma Rule identifies very low-risk pediatric head injury patients (ages 0-18 years) who can safely avoid CT imaging without missing clinically important traumatic brain injuries, reducing unnecessary radiation exposure. Developed from a multicenter prospective cohort study of over 42,000 children with blunt head trauma, this rule defines minimal risk based on specific clinical variables assessed at the time of presentation. Use this calculator in the emergency department to guide imaging decisions in children presenting with head trauma and determine whether observation alone is appropriate versus CT neuroimaging.

Clinically Verified· 5 tests

For educational and informational purposes only. Verify all results before clinical application.

Age Group *

GCS <15 *

Glasgow Coma Scale less than 15 at time of assessment

Altered Mental Status *

Agitation, somnolence, repetitive questioning, slow response

Palpable Skull Fracture *

For <2 years only: palpable skull fracture

Signs of Basilar Skull Fracture *

For ≥2 years only: raccoon eyes, Battle sign, hemotympanum, CSF leak

Scalp Hematoma *

For <2 years only: scalp hematoma (except small frontal)

Loss of Consciousness *

Any loss of consciousness

Severe Mechanism of Injury *

MVC with ejection / occupant death, pedestrian, fall >1.5m (<2y) or >3m (≥2y), high-impact object to head

Acting Normally *

Acting normally as observed by parents

Vomiting *

Severe Headache *

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.[DOI]

Reviewed by Daniel Diaz-Gil, MD · Last updated March 2026

Medical disclaimer

This tool is for educational and informational purposes only. It is not a substitute for professional clinical judgment. Always independently verify results before making clinical decisions.

Professional Resources — Tools used by pediatricians for clinical scoring

PEWS Reference CardsPediatric Early Warning Score quick-reference cards for bedside use~$15via Amazon Pediatric Digital ScaleAccurate weight measurement for clinical assessment~$40via Amazon BoardVitals Pediatrics QbankBoard-style questions for general pediatrics certificationsubscriptionvia BoardVitals