EBMcalc Medical Calculator

PECARN Head Trauma Head CT Decision Tree

The EBMcalc module PECARN Head Trauma Head CT Decision Tree is available in EBMcalc Complete Edition.

This Decision TreeCalc evaluates the following decision points:

Select patient age
Is there altered mental status?
What is the GCS? (this calculator is not for patients with a GCS <14)
Is there a palpable skull fracture?
Is there a scalp hematoma in the parietal, occipital, or temporal areas?
Was there loss of conciousness for 5 seconds or more?
Was the mechanism of injury severe (see below)?
Do parents report the patient is acting abnormally?
Are there signs of basilar skull fracture?
Was there loss of consiousness?
Was there vomiting or severe headache?

Decision Tree end points include:

Head CT scan recommended. There is a 4.4% risk of clinically important Traumatic Brain Injury (ciTBI) on neuroimaging for age <2 years old.
Observation versus head CT recommended depending on other clinical factors (see below). There is a 0.9% risk of clinically important Traumatic Brain Injury (ciTBI) on neuroimaging for age <2 years old.
Head CT not recommended. There is <0.02% risk of clinically important Traumatic Brain Injury (ciTBI) on neuroimaging for age <2 years old.
Head CT scan recommended. There is a 4.3% risk of clinically important Traumatic Brain Injury (ciTBI) on neuroimaging for age ≥2 years old.
Head CT not recommended. There is <0.05% risk of clinically important Traumatic Brain Injury (ciTBI) on neuroimaging for age ≥2 years old
Observation versus head CT recommended depending on other clinical factors (see below). There is a 0.8% risk of clinically important Traumatic Brain Injury (ciTBI) on neuroimaging for age ≥2 years old

References

Kuppermann N, Holmes JF, Dayan PS, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009 Oct 3;374(9696):1160-70. PubMed ID: 19758692
Abid Z, Kuppermann N, Tancredi DJ, Dayan PS. Risk of Traumatic Brain Injuries in Infants Younger than 3 Months With Minor Blunt Head Trauma. Ann Emerg Med. 2021 Sep;78(3):321-330.e1. PubMed ID: 34148662

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