PECARN Head CT

Identify children at very low risk of clinically important TBI after head trauma

Indication

Identify children at very low risk of clinically important TBI after head trauma

id: age_group; label: Age group; type: options; options: label: < 2 years; value: 1; label: ≥ 2 years; value: 0
id: gcs_lt15; label: GCS < 15 (or altered mental status); type: yesno; points: 1
id: skull_fx; label: Palpable skull fracture (<2y) or signs of basilar skull fracture (≥2y); type: yesno; points: 1
id: loc; label: Loss of consciousness ≥5 seconds; type: yesno; points: 1
id: severe_mech; label: Severe mechanism (MVC, fall >3ft (<2y) or >5ft (≥2y), head struck by high-impact object); type: yesno; points: 1
id: acting; label: Not acting normally per parent (<2y) or severe headache/vomiting (≥2y); type: yesno; points: 1
id: hematoma; label: Scalp hematoma (occipital/parietal/temporal if <2y); type: yesno; points: 1

function(score) { if (score <= 0) return { risk: 'Very Low', tier: 'Very Low Risk', action: 'ciTBI risk <0.05%. CT not recommended. Observe.', color: 'green' }; if (score === 1) return { risk: 'Low', tier: 'Low Risk', action: 'ciTBI risk <0.9%. Consider observation vs. CT based on clinical factors.', color: 'yellow' }; return { risk: 'Not Low', tier: 'Elevated Risk', action: 'CT recommended. Multiple risk factors present.', color: 'red' }; }

Validated in >42,000 children — 96.8-100% sensitivity for ciTBI
Two separate algorithms: one for <2 years, one for ≥2 years
GCS <15 or palpable skull fracture → CT recommended
Isolated findings in intermediate risk: observation for 4-6 hours is a valid alternative to CT