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''Rules below are according to the of [[EBQ:PECARN_Pediatric_Head_CT_Rule|PECARN Head CT Study]]<ref>[[EBQ:PECARN_Pediatric_Head_CT_Rule|PECARN Rule]]  Kupperman 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 374(9696): 1160, 2009</ref>''
===<2 years old===
===<2 years old===
;Any 1 of the following?
[[File:PECARN Under Age 2.jpg|thumb|PECARN Under Age 2]]
#GCS ≤14
====Any 1 of the following?====
#Altered Mental Status
*GCS ≤14
#Palpable skull Fracture
*[[Altered Mental Status]]
''Then obtain a Non-Con Brain CT (4.4% risk of cTBI)''
*Palpable [[Skull Fracture]]
''Then '''obtain''' a Non-Con Brain CT (4.4% risk of cTBI)''


;1 or more of the following?
====1 or more of the following?====
#Non-frontal scalp hematoma
*Non-frontal scalp hematoma
#LOC ≥ 5 seconds
*LOC ≥ 5 seconds
#Severe injury mechanism
*Severe injury mechanism
#Abnormal activity per parents
**pedestrian or bicyclist without helmet struck by motorized vehicle
''Then consider a Non-Con Brain CT or Observation (0.9% risk of cTBI)''
**fall >1m or 3ft
**head struck by high-impact object
*Abnormal activity per parents
''Then '''consider''' a Non-Con Brain CT or Observation (0.9% risk of cTBI)''


===≥2 years old - 18 years===
===≥2 years old - 18 years===
;Any 1 of the following?
[[File:PECARN Age 2 and Up.jpg|thumb|PECARN Age 2 and Up]]
#GCS ≤14
====Any 1 of the following?====
#Altered Mental Status
*GCS ≤14
#Signs of a basilar skull fracture
*[[Altered Mental Status]]
''Then obtain a Non-Con Brain CT (4.3% risk of cTBI)''
*Signs of a [[basilar skull fracture]]
 
''Then '''obtain''' a Non-Con Brain CT (4.3% risk of cTBI)''
;1 or more of the following?
#History of vomitting
#LOC
#Severe injury mechanism
#Severe headache
''Then consider a Non-Con Brain CT or Observation (0.9% risk of cTBI)''
 


===< 2yr old===
====1 or more of the following?====
*No CT is necessary if ALL are found:
*History of [[vomiting]]^
#Normal mental status
*LOC
#No scalp hematoma except frontal
*Severe injury mechanism
##LOC <5s
**Pedestrian or bicyclist without helmet struck by motorized vehicle
#Non-severe mechanism
**Fall >2m or 5ft
##Severe mechanism = pedestrian or bicyclist w/o helmet struck by motorized vehicle
**Head struck by high-impact object
##Severe mechanism = fall >1m or 3ft
*Severe [[headache]]
##Severe mechanism = head struck by high-impact object
''Then '''consider''' a Non-Con Brain CT or Observation (0.9% risk of cTBI)''
#No palpable skull fracture
#Normal behavior per parents


===>2yr old===
^Consider observation in place of imaging in children with isolated vomiting (no other indication) as the sole risk factor (0.2% risk of cTBI)<ref>Dayan PS, et al. "Association of Traumatic Brain Injuries with Vomiting in Children with Blunt Head Trauma.  June 2014. Annals of EM. 63(6):657-665</ref>
*No CT is necessary if ALL are found:
#Normal mental status
#No LOC
#No vomiting
#Non-severe mechanism:
##Severe mechanism = pedestrian or bicyclist w/o helmet struck by motorized vehicle
##Severe mechanism = fall >2m or 5ft
##Head struck by high-impact object
#No signs of basilar skull fracture
#No severe headache

Revisión actual - 22:07 5 oct 2019

Rules below are according to the of PECARN Head CT Study[1]

<2 years old

PECARN Under Age 2

Any 1 of the following?

Then obtain a Non-Con Brain CT (4.4% risk of cTBI)

1 or more of the following?

  • Non-frontal scalp hematoma
  • LOC ≥ 5 seconds
  • Severe injury mechanism
    • pedestrian or bicyclist without helmet struck by motorized vehicle
    • fall >1m or 3ft
    • head struck by high-impact object
  • Abnormal activity per parents

Then consider a Non-Con Brain CT or Observation (0.9% risk of cTBI)

≥2 years old - 18 years

PECARN Age 2 and Up

Any 1 of the following?

Then obtain a Non-Con Brain CT (4.3% risk of cTBI)

1 or more of the following?

  • History of vomiting^
  • LOC
  • Severe injury mechanism
    • Pedestrian or bicyclist without helmet struck by motorized vehicle
    • Fall >2m or 5ft
    • Head struck by high-impact object
  • Severe headache

Then consider a Non-Con Brain CT or Observation (0.9% risk of cTBI)

^Consider observation in place of imaging in children with isolated vomiting (no other indication) as the sole risk factor (0.2% risk of cTBI)[2]

  1. ↑ PECARN Rule Kupperman 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 374(9696): 1160, 2009
  2. ↑ Dayan PS, et al. "Association of Traumatic Brain Injuries with Vomiting in Children with Blunt Head Trauma. June 2014. Annals of EM. 63(6):657-665
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