Interpretation
| Result | Meaning |
|---|---|
| GCS 14/AMS or signs of basilar skull fracture | CT recommended; ciTBI 4.3% |
| Any of: LOC, vomiting, severe mechanism, severe headache | Observation vs CT; ciTBI 0.9% |
| None | CT not recommended; ciTBI <0.05% |
Formula
Step 1: GCS 14 / altered mental status or signs of basilar skull fracture → CT. Step 2: history of LOC, vomiting, severe mechanism, or severe headache → observation vs CT. Otherwise → no CT.
Clinical pearls
- Inclusion: children 2–17 y presenting within 24 h of head trauma with GCS 14–15. Excluded: trivial mechanisms (ground-level falls, walking or running into stationary objects with only scalp abrasions/lacerations), penetrating trauma, known brain tumours, pre-existing neurological disorders, ventricular shunts, bleeding disorders, or prior outside neuroimaging.
- Severe mechanism (≥2 y): MVC with ejection, death of another passenger or rollover; pedestrian or unhelmeted cyclist struck by motorised vehicle; fall >5 ft (1.5 m); head struck by high-impact object.
- Isolated findings in the intermediate group (e.g. vomiting alone) carry very low risk; observation is usually reasonable.
Examples
pecarn 8 yo fell off bike with helmet, vomited once, gcs 15, no locdoes a 5 year old who fell 6 feet off a climbing frame, no LOC, no vomiting, need a head CT
FAQ
Does an isolated episode of vomiting need a CT?
Not usually. Isolated vomiting places a child in the intermediate group, where observation is generally appropriate.
What counts as altered mental status?
GCS 14, or agitation, somnolence, repetitive questioning, or slow response to verbal communication.