Head CT (Peds)

< 2 yr old

no CT if all below negative

1. AMS (GCS ≥14)
2. Scalp hematoma (frontal hematoma is ok)
3. LOC > 5sec
4. Palpable skull fracture
5. Acting normal per parent
6. Severe mechanism of injury
   1. Fall >3ft (>0.9m)
   2. Head struck by high-impact object
   3. MVC w/ pt ejection, death of passenger, or rollover
   4. Pedestrian or bicyclist struck by motorized vehicle

CT if either of the following

1. AMS
2. Evidence of skull fracture

CT versus observation

If any (except AMS or e/o fracture) are positive, obs vs CT depending on:

1. physician experience
2. multiple versus isolated findings
3. worsening symptoms after ED obs
4. age <3 months
5. parental preference

> 2 yr old

no CT if all below negative

1. AMS (GCS ≥14)
2. LOC
3. History of vomiting
4. Clinical signs of basilar skull fracture
5. Severe headache
6. Severe mechanism of injury
   1. Fall >5ft (>1.5m)
   2. Head struck by high-impact object
   3. MVC w/ pt ejection, death of passenger, or rollover
   4. Pedestrian or bicyclist struck by motorized vehicle

CT if either of the following

1. AMS
2. Signs of basilar skull fracture

CT versus observation

If any (except AMS or e/o fracture) are positive, obs vs CT depending on:

1. physician experience
2. multiple versus isolated findings
3. worsening symptoms or signs after ED obs
4. parental preference

NPV > 99% PPV > 99%

See Also

Head Trauma (Minor) (Peds)

GCS (Peds)

Concussion

Skull Fracture

Abuse (Nonaccidental Trauma)

Head Trauma (Adult)

Source

PECARN- Kupperman 2009