PECARN Pediatric Head Injury Rule
PECARN pediatric head-injury rule (Kuppermann 2009): age-branched (<2 vs >=2 y) high/intermediate/very-low risk tier for clinically important TBI after blunt head trauma with GCS 14-15, guiding CT vs observation.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Age
- 5 years
- GCS = 15
- Yes
- Palpable skull fracture
- No
- Signs of basal skull fracture
- No
- Other signs of altered mental status
- No
- LOC >= 5 seconds (age <2) / any LOC
- No
- Vomiting
- No
- Severe mechanism of injury
- No
- Occipital, parietal, or temporal scalp hematoma
- No
- Not acting normally per parent
- Yes
- Severe headache
- No
Result: Very low risk: ciTBI <0.05% per Kuppermann 2009. CT not recommended.
The tool opens with these values already filled in. Replace them with your own.
What the result means
- very low
- ciTBI <0.02% (age <2) / <0.05% (age >=2) per Kuppermann 2009. CT not recommended.
- intermediate
- ciTBI ~0.9% per Kuppermann 2009. Observation vs CT based on the Kuppermann 2009 shared-decision factors.
- high
- ciTBI ~4.4% (age <2) / ~4.3% (age >=2) per Kuppermann 2009. CT recommended.
What you enter
- Age (years)
- GCS = 15 (uncheck if GCS 14 or other AMS)
- Palpable skull fracture (age <2 only)
- Signs of basal skull fracture (age >=2)
- Other signs of altered mental status
- LOC >= 5 seconds (age <2) / any LOC (age >=2)
- Vomiting (age >=2 only)
- Severe mechanism of injury
- Occipital, parietal, or temporal scalp hematoma (age <2 only)
- Not acting normally per parent (age <2 only)
- Severe headache (age >=2 only)
How this is calculated
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;374(9696):1160-1170. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.