Interpretation
| Result | Meaning |
|---|---|
| GCS 14/AMS or palpable skull fracture | CT recommended; ciTBI 4.4% |
| Any of: non-frontal scalp hematoma, LOC ≥5 s, severe mechanism, not acting normally | Observation vs CT; ciTBI 0.9% |
| None | CT not recommended; ciTBI <0.02% |
Formula
Step 1: GCS 14 / altered mental status or palpable skull fracture → CT. Step 2: occipital/parietal/temporal scalp hematoma, LOC ≥5 s, severe mechanism, or not acting normally per parent → observation vs CT. Otherwise → no CT.
Clinical pearls
- Inclusion: children <18 y (this branch <2 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 >3 ft (0.9 m); head struck by high-impact object.
- For the intermediate group, favour CT with multiple findings, worsening symptoms, age <3 months, physician inexperience or parental preference.
Examples
pecarn 14 month old fell off bed 2 ft, acting normally, small frontal bump, no locbaby 10 months fell 4 feet down stairs, parietal hematoma, GCS 15
FAQ
What is altered mental status in PECARN?
GCS 14, or agitation, somnolence, repetitive questioning, or slow response to verbal communication.
What is a clinically important TBI?
Death from TBI, neurosurgery, intubation >24 h for TBI, or hospital admission ≥2 nights for TBI with positive CT.