PECARN Rule for Pediatric Head Injury ≥ 2 years old

Assess the need for neuroimaging in pediatric head trauma

PECARN Rule for Pediatric Head Injury ≥ 2 years old

Assess the need for neuroimaging in pediatric head trauma

PECARN Rule for Pediatric Head Injury ≥ 2 years old

Assess the need for neuroimaging in pediatric head trauma

PECARN Rule for Pediatric Head Injury ≥ 2 years old

Assess the need for neuroimaging in pediatric head trauma

1.Age ≥ 2 years old
2.GCS ≤ 14
3.Signs of basilar skull fracture
4.Altered mental status
5.History of loss of consciousness
6.History of vomiting
7.Severe headache
8.Severe mechanism of injury
Created by on 29/03/2018

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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 4.3% of children had clinically significant traumatic brain injury on neuroimaging
  • GCS ≤ 14
  • Signs of basilar 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
  • History of loss of consciousness
  • History of vomiting
  • History of severe headache
  • Severe mechanism of injury

Absence of any of those features found ≤ 0.05% 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

1. Age ≥ 2 years old

Created by on 29/03/2018

By using this site you acknowledge that you have read, understand, and agree to be bound by our terms of use and privacy policy. All content and tools are for educational use only, are not meant to be a substitute for professional advice and should not be used for medical diagnosis and/or medical treatment.

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