PECARN Rule for Pediatric Head Injury < 2 years old

Assess the need for neuroimaging in pediatric head trauma

The global unit selector only affects unanswered questions
1.Age < 2 years old
2.GCS ≤ 14
3.Palpable skull fracture
4.Altered mental stat
5.Occipital, parietal, or temporal scalp hematoma
6.History of loss of consciousness ≥ 5 seconds
7.Not acting normally as per parent
8.Severe mechanism of injury
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1. Age < 2 years old

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About this Calculator

The PECARN rule was developed to assist in decision making for neuroimaging in children with head trauma

Studies enrolled and analyzed 42412 children (derivation and validation totals 8502 and 2216 age <2 years and 25283 and 6411 ≥ 2 years respectively). The prediction rule had a negative predictive value of 100% (95% CI 99.7-100.0) and sensitivity of 100% (86.3-100.0) for clinically significant traumatic brain injury (cTBI) in children < 2 years of age. The prediction rule had a negative predictive value of 99.95% (99.81-99.99) and sensitivity of 96.8% (89.0-99.6) for clinically significant traumatic brain injury (cTBI) in children ≥ 2 years of age.

Kuppermann et al. have derived a clinical decision rule that has been externally validated to identify children with very low risk of cTBI. In these identified children, routine CT scanning is not necessary.

The risk of clinically significant traumatic brain injury is calculated as follows:

Variable & Associated Points

  • For children age < 2 years old
  • Presence of any of the following high-risk features found 4.4% of children had clinically significant traumatic brain injury on neuroimaging
  • GCS ≤ 14
  • Palpable skull fracture
  • Altered mental status
  • Presence of any of the following features found 0.9% of children had clinical significant traumatic brain injury on neuroimaging
  • Occipital, parietal, or temporal scalp hematoma
  • History of loss of consciousness ≥ 5 seconds
  • Not acting normally as per parent
  • Severe mechanism of injury

Absence of any of those features found < 0.02% of children had clinical significant traumatic brain injury on neuroimaging

References

Kuppermann, N., Holmes, J., Dayan, P., Hoyle, J., Atabaki, S., Holubkov, R., Nadel, F., Monroe, D., Stanley, R., Borgialli, D., Badawy, M., Schunk, J., Quayle, K., Mahajan, P., Lichenstein, R., Lillis, K., Tunik, M., Jacobs, E., Callahan, J., Gorelick, M., Glass, T., Lee, L., Bachman, M., Cooper, A., Powell, E., Gerardi, M., Melville, K., Muizelaar, J., Wisner, D., Zuspan, S., Dean, J. and Wootton-Gorges, S.

Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study.

Lancet 2009 October 3, 374 (9696): 1160-70

Schonfeld, D., Bressan, S., Da Dalt, L., Henien, M., Winnett, J. and Nigrovic, L.

Pediatric Emergency Care Applied Research Network head injury clinical prediction rules are reliable in practice.

Archives of Disease in Childhood 2014, 99 (5): 427-31

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