Free tool · Scored assessment · Peds / ER
PECARN Pediatric Head Injury.
The validated rule that helps identify which children with minor blunt head trauma are at very low risk of a clinically-important traumatic brain injury (ciTBI) — and can often safely avoid a CT. Pick the age algorithm (under 2 or 2 and older), check what’s present, and get the recommendation: CT recommended, observation vs CT (shared decision), or CT not recommended. Built from Kuppermann / PECARN 2009. The rule supports — never replaces — provider judgment.
Applies to: children with GCS 14–15 and minor blunt head trauma within 24 hours. Not for trivial mechanisms with no signs/symptoms, penetrating trauma, known brain tumors, or pre-existing neurologic disorders.
Step 1 — high-risk predictors
If any of these is present, CT is recommended.
Step 2 — other (intermediate) predictors
Check only if none of the Step 1 predictors are present.
Choose the age algorithm and check what applies.
How PECARN stratifies risk [1]
In the derivation/validation cohort of >42,000 children, the rule identified groups at predictable ciTBI risk. High-risk predictors present → CT recommended (ciTBI risk ≈4.4% under 2 / ≈4.3% age ≥2). Intermediate predictors only → observation vs CT (ciTBI risk ≈0.9%); CT may be guided by clinician experience, multiple vs isolated findings, worsening symptoms, age <3 months, or parental preference. No predictors → CT not recommended (ciTBI risk ≈0.02% under 2 / ≈0.05% age ≥2). “Severe mechanism” = MVC with ejection, death of another passenger, or rollover; pedestrian/bicyclist without helmet struck by a vehicle; fall >0.9 m (3 ft) if under 2 or >1.5 m (5 ft) if ≥2; or head struck by a high-impact object.
References
- Kuppermann N, Holmes JF, Dayan PS, et al; Pediatric Emergency Care Applied Research Network (PECARN). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160–1170. PMID: 19758692. (Derivation and validation of the age-stratified rule; ciTBI risk estimates and severe-mechanism definitions.)
Predictors, age cutoffs, and risk estimates transcribed from the PECARN study. Imaging decisions are individualized by the care team.
Pairs well with