EBQ:PECARN Pediatric Head CT Rule

Under Review Journal Club Article

Kuppermann N. et al. "Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study.". The Lancet. 2009. 374(9696):1160-1170.
PubMed Full text PDF

Clinical Question

Can children be identified for low risk clinically-important traumatic brain injury and avoid Brain CT imaging.

Conclusion

This validated clinical decision rule provides a means of decreasing brain CT imaging in children with blunt head trauma with a sensitivity of 100% (<2years old) and 96.8% (>2yrs old) for intracraneal injuries

Major Points

This rule was derived from the multicenter PECARN network with both an derivation and validation arm. Clinically important traumatic brain (cTBI) injury was defined as: death, intubation for > 24hrs, injury requiring neurosurgical intervetion, or a hospital admission ≥ 2 nights.

The rule stratifies patients < 2 years old and ≥2 years old.

<2 years old

Any 1 of the following?

1. GCS ≤14
2. Altered Mental Status
3. Palpable skull Fracture

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

1 or more of the following?

1. Non-frontal scalp hematoma
2. LOC ≥ 5 seconds
3. Severe injury mechanism
4. Abnormal activity per parents

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

≥2 years old

Any 1 of the following?

1. GCS ≤14
2. Altered Mental Status
3. Signs of a basilar skull fracture

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

1 or more of the following?

1. History of vomitting
2. LOC
3. Severe injury mechanism
4. Severe headache

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

Review Questions

Journal club article: Regarding pediatric head trauma patients, which of the following were predictors of “very low risk for clinically significant injury in children less than 2 years of age”?

	normal mental status
	no scalp hematoma except frontal
	no loss of consciousness or loss of consciousness < 5 seconds
	non-severe injury mechanism
	no palpable skull fracture