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Head injuries in children over 2yo are stress provoking as well. Here are the rules for that age group, piggy-backing on last week's pearl, based on a large (42,412 children, 31,694 >2yo) multi-center trial conducted by PECARN.
In children >2yo, if all of the following criteria are met, there is 99.95% chance that no clinically important traumatic brain injury exists (defined as an injury requiring intervention):
- normal mental status
- no loss of consciousness
- no vomiting
- non-severe injury mechanism
- no signs of basilar skull fracture
- no severe headache
No children in either low risk group required neurosurgical intervention.
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.Lancet2009;374:1160-