The PECARN rules separate children with minor head injury into three groups, with different criteria under and over two years. Under two: CT if GCS below 15, altered mental status or a palpable skull fracture. Two and over: CT if GCS below 15, altered mental status or signs of basal skull fracture. Children with only intermediate features can usually be observed rather than scanned, depending on the number of features, how they progress and parental preference. Children with none of these features are at very low risk and need no CT.
- Under 2, intermediate: non-frontal scalp haematoma, LOC ≥5 s, severe mechanism, not acting normally
- 2 and over, intermediate: any LOC, vomiting, severe mechanism, severe headache
- Intermediate risk: observation for 4–6 hours is often reasonable
- Worsening during observation: scan
Why it matters
A validated rule is the simplest way to avoid radiation in children who do not need a scan.
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