PECARN themes

13 Nov

Why don’t we just CT everybody?

  • estimated risk of lethal malignancy from a head CT
    • 1 year old -> 1 in 1000-1500
    • 10 year old -> 1 in 5000
  • clinically-important traumatic brain injuries in children was RARE
    • 0.9% had a clinically-important traumatic brain injury
    • 0.1% underwent surgery
    • study of over 42,000 children


Check out MDCalc’s handy tool for using the PECARN rule, but some common themes prevail:

  • GCS =14 (PECARN study included those with GCS 14-15, but GCS <14 would not be particularly reassuring)
  • signs of basilar skull fx (or palpable fx if < 2yo)
  • altered mental status (e.g. Agitation, somnolence, repetitive questioning, or slow response)
  • if <2 yo, scalp hematoma
  • LOC
  • vomiting
  • severe headache
  • severe mechanism of injury


risk of clinically important TBI, if you had:

  • none of the above: risk is <0.05 %
  • any of the RED clues: risk is 4+ %, probably should CT
  • no RED, but any of the other clues: risk 0.9%, consider obs vs CT


References: MDCalc; picture



2 Responses to “PECARN themes”

  1. Nathalie December 3, 2014 at 13:32 #

    You mention common themes for clinically important traumatic brain injuries, one being GCS<=14. From my understanding PECARN only looked at and applies to children with GCS 14-15, not applicable to those with a GCS less than 14. Is that correct?

    • dailyem December 7, 2014 at 19:23 #

      Apologies for the confusion. Yes, you are correct, PECARN only looked at kids with GCS 14-15; and a GCS of 14 (so, not 15) bought you a “CT recommended” with a 4.x % risk of clinically important TBI. But given a patient with a GCS of 13 or lower, you could not really apply the PECARN rule for the reason you mentioned, though many of us would consider CT in that population (kid with lower GCS) anyways; so conceptually, this was shorthand representation of considering CT in a kid with GCS <=14. I will amend the post to clarify a bit. Thanks for your comment!

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