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Clinically important traumatic brain injuries are rare in children. The PECARN study provides decision rules for when to avoid unnecessarily obtaining a CT for children who have suffered head trauma.
For children < 2 years old: <0.02% risk of clinically important TBI
- Normal mental status
- No scalp hematoma, except frontal
- Loss of consciousness < 5 seconds
- No palpalble skull fracture
- Normal behavior
- Nonsevere mechanism (fall < 3ft, pedestrian struck, rollover MVC)
For children > 2 years old: <0.05% risk of clinically important TBI
- Normal mental status
- No signs of basilar skull fracture
- No loss of consciousness
- No vomiting
- No severe headache
- Nonsever mechanism (fall < 5ft, pedestrian struck, rollover MVC)
References
Kuppermann N, et al. Pediatric Emergency Care Applied Research Network. Identification of childrent at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 2009 Oct 3;374(9696):1160-70.