PECARN Pediatric Head Injury Algorithm

Learn about the PECARN Pediatric Head Injury/Trauma Algorithm for evaluating children with blunt head trauma. Explore criteria, clinical significance, indications, and limitations.

PECARN Pediatric Head Injury Algorithm

PECARN Pediatric Head Trauma Assessment

Enter patient age and clinical findings to determine CT scan necessity using the PECARN algorithm for pediatric head injury evaluation and ciTBI risk assessment.

Patient Age (years) *

Age determines which PECARN criteria apply (< 2 years vs ≥ 2 years)

Glasgow Coma Scale Score *

GCS < 15 indicates high risk for ciTBI

Criteria for Children < 2 Years

Palpable skull fracture

Altered mental status (agitation, somnolence, repetitive questioning)

Scalp Hematoma Location:

Occipital hematoma

Parietal hematoma

Temporal hematoma

Loss of consciousness ≥ 5 seconds

Severe mechanism (MVC with ejection, fall > 0.9m)

Not acting normally per parent

Disclaimer: This calculator is for educational purposes only and should not replace clinical judgment. The PECARN algorithm is a clinical decision support tool. Always consult with a healthcare professional for medical decisions.

PECARN Algorithm Formula Explained

PECARN Pediatric Head Injury Algorithm

The Pediatric Emergency Care Applied Research Network (PECARN) algorithm is a clinical decision rule designed to identify children at very low risk for clinically important traumatic brain injury (ciTBI). It helps reduce unnecessary CT scans while maintaining patient safety.

Algorithm Formula:

IF (Age < 2 years) THEN evaluate criteria for children < 2 years

IF (Age ≥ 2 years) THEN evaluate criteria for children ≥ 2 years

IF (Any positive criterion) THEN CT scan indicated (High Risk)

IF (No positive criteria) THEN CT scan not indicated (Low Risk)

Algorithm Decision Tree

Determine patient age

Age < 2 years → Apply criteria for children < 2 years

Age ≥ 2 years → Apply criteria for children ≥ 2 years

Evaluate age-specific criteria

Make decision based on criteria

Any positive criterion → HIGH RISK → CT scan indicated

No positive criteria → LOW RISK → CT scan not indicated

Age-Specific Criteria

Children < 2 Years

• GCS < 15: Any score below 15
• Palpable skull fracture: Palpable deformity
• Altered mental status: Agitation, somnolence, repetitive questioning
• Scalp hematoma: Occipital, parietal, or temporal location
• Loss of consciousness: ≥ 5 seconds
• Severe mechanism: MVC with ejection, fall > 0.9m
• Not acting normal: Per parent assessment

Children ≥ 2 Years

• GCS < 15: Any score below 15
• Basilar skull fracture: Signs of basilar skull fracture
• Altered mental status: Any alteration in mental status
• Loss of consciousness: Any duration
• Vomiting: History of vomiting
• Severe headache: Severe headache complaint
• Severe mechanism: Fall > 1.5m, MVC with ejection

Risk Stratification

High Risk

Criteria: Any positive PECARN criterion

Recommendation: Immediate CT scan

Action: Consider neurosurgery consultation

Low Risk

Criteria: No positive PECARN criteria

Recommendation: CT scan not indicated

Action: Discharge with head injury instructions

Clinical Applications

Emergency Department Use

• Rapid assessment of pediatric head trauma patients
• Reduce unnecessary CT scans and radiation exposure
• Standardize clinical decision-making
• Improve resource utilization

Benefits

• Validated in multiple clinical settings
• High sensitivity for detecting ciTBI
• Reduces healthcare costs
• Improves patient safety

Important Limitations

• Clinical judgment required: Algorithm should not replace clinical judgment
• Patient/family concerns: Consider patient and family concerns in decision-making
• Follow-up needed: Ensure appropriate follow-up for discharged patients
• Documentation: Document all findings and decision-making process
• Special populations: Consider special populations and comorbidities

The PECARN Pediatric Head Injury/Trauma Algorithm is a validated clinical decision-making tool developed by the Pediatric Emergency Care Applied Research Network (PECARN). It is used to assess children with blunt head trauma and identify those at very low risk for clinically important traumatic brain injuries (ciTBI). By applying this algorithm, clinicians can safely determine which patients do not require head computed tomography (CT) scans, thereby minimizing unnecessary radiation exposure while ensuring timely diagnosis of serious injuries.

Traumatic brain injury is one of the leading causes of morbidity and mortality in children. However, most children presenting with head trauma have minor injuries. The PECARN algorithm helps balance the need for accurate diagnosis with the imperative to avoid exposing children to the long-term risks of ionizing radiation from CT scans.

Development and Validation

The PECARN rule was derived and validated in a large, multicenter study involving over 42,000 children across the United States. It is stratified into two age groups—< 2 years and ≥ 2 years—to account for differences in physiology, injury mechanisms, and symptom presentation in younger versus older children.

PECARN Criteria for Children Under 2 Years

For children younger than 2 years with blunt head trauma, the following predictors are considered:

Normal mental status
No scalp hematoma (except frontal)
No loss of consciousness (LOC) or LOC < 5 seconds
Non-severe mechanism of injury
No palpable skull fracture
Acting normally according to the parents

If all of these criteria are met, the child is at very low risk of clinically important traumatic brain injury, and a head CT scan is generally not required.

PECARN Criteria for Children Aged 2 Years and Older

For children aged 2 years or older, the predictors include:

Normal mental status
No loss of consciousness
No vomiting
Non-severe mechanism of injury
No signs of basilar skull fracture
No severe headache

Meeting all of these criteria indicates a very low risk of ciTBI, making CT scanning unnecessary in most cases.

Definition of Clinically Important TBI (ciTBI)

The PECARN algorithm specifically addresses the risk of ciTBI, which includes:

Death from traumatic brain injury
Need for neurosurgical intervention
Intubation lasting more than 24 hours due to head injury
Hospital admission for ≥ 2 nights associated with head trauma and positive imaging findings

Clinical Significance

The PECARN algorithm has revolutionized pediatric emergency care by:

Reducing CT utilization: Significantly lowers the number of unnecessary head CTs in children with minor trauma.
Enhancing patient safety: Minimizes radiation exposure, reducing the long-term risk of malignancies.
Standardizing care: Provides an evidence-based framework for consistent evaluation across institutions.
Maintaining sensitivity: Studies show the algorithm has a near 100% sensitivity for detecting ciTBI in low-risk children.

Indications for Use

The PECARN algorithm should be applied in:

Children presenting with blunt head trauma within the last 24 hours.
Cases where the clinician’s concern for ciTBI is low to intermediate.
Emergency departments or urgent care settings to guide CT decision-making.

Limitations

Despite its strengths, PECARN has limitations:

Not for high-risk patients: Children with obvious skull fractures, penetrating trauma, or Glasgow Coma Scale (GCS) ≤ 13 should bypass PECARN and undergo immediate imaging.
Clinical judgment required: The tool supplements but does not replace physician expertise.
Exclusion criteria: Not validated for children with bleeding disorders, prior neurosurgery, or ventricular shunts.
Parental reporting: Reliance on caregiver observation (e.g., “acting normally”) introduces subjectivity.