"Risk of radiation-induced malignancy exceeds risk of occult bleed. Safe for discharge with guidance."
Validated PECARN Decision Tool.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Evaluating paediatric patients (< 18 years) with minor head trauma (GCS 14–15).
Decision support to avoid unnecessary head CT scans in children.
Identifying patients at high risk for clinically important TBI (ciTBI).
Use only for GCS 14, 15, or infant acting normally.
Section 2
Formula & Logic
Risk Stratification
Risk Group
Infants (< 2yr)
Children (≥ 2yr)
High Risk
GCS 14 OR Palpable fracture OR Altered status
GCS 14 OR Basilar fracture signs OR Altered status
Intermediate
Hematoma (non-frontal) OR LOC ≥5s OR Severe mech OR Not acting normally
Vomiting OR LOC history OR Severe mech OR Severe headache
Low Risk
None of the above
None of the above
Section 3
Pearls/Pitfalls
The ALARA Principle
In the Low Risk group, the sensitivity for ciTBI is effectively 100%. PECARN is the gold standard for upholding the ALARA (As Low As Reasonably Achievable) principle of radiation, as the risk of a radiation-induced malignancy in a toddler is significantly higher than the risk of a missed bleed in the low-risk cohort.
Section 4
Evidence Appraisal
Primary Reference
Identification of children at very low risk of clinically-important traumatic brain injuries after head trauma: a prospective cohort study
Kuppermann N et al. • Lancet. 2009;374(9696):1160-1170
