PECARN Calculator
Pediatric Emergency Care Applied Research Network head injury assessment
Patient Assessment
PECARN criteria apply to children under 18 years
High-Risk Criteria (<2 years)
Any of these criteria indicate high risk for clinically important TBI:
Intermediate-Risk Criteria (<2 years)
These criteria may warrant further evaluation:
PECARN Assessment Results
Very low risk for clinically important traumatic brain injury
Primary Recommendation
CT scan not recommended
Clinical Recommendations
- •CT scan not routinely recommended
- •Provide caregiver with head injury instructions
- •Advise when to return for medical care
- •Consider other causes of symptoms if present
Example Cases
High Risk Case
Patient: 18-month-old with GCS 13 after fall from stairs
Assessment: High risk criteria present (GCS <15)
Recommendation: CT scan recommended
Intermediate Risk Case
Patient: 4-year-old with vomiting after bicycle accident
Assessment: Intermediate risk criteria present
Recommendation: Consider CT or observation period
Low Risk Case
Patient: 3-year-old with minor bump, no symptoms
Assessment: No high or intermediate risk criteria
Recommendation: CT scan not routinely needed
About PECARN
PECARN (Pediatric Emergency Care Applied Research Network) provides evidence-based decision rules for pediatric head injuries.
Risk Categories
High Risk
TBI risk: ~4.4%
CT scan recommended
Intermediate Risk
TBI risk: ~0.9%
Clinical judgment needed
Very Low Risk
TBI risk: <0.05%
CT not routinely needed
Key Definitions
Agitation, somnolence, slow response, repetitive questioning
MVC with ejection/rollover/death, significant fall, high-impact strike
Brain injury requiring neurosurgical intervention or resulting in death
Red Flags
- Persistent vomiting
- Seizures
- Focal neurological deficits
- Signs of increased ICP
- Worsening headache
- Behavioral changes
- Difficulty staying awake
- Balance problems
Understanding PECARN Guidelines
Clinical Purpose
The PECARN decision rules help clinicians identify children at very low risk for clinically important traumatic brain injuries, reducing unnecessary CT exposure while ensuring appropriate imaging for high-risk patients.
Age-Based Approach
- •<2 years: Includes parental concern and scalp hematoma
- •≥2 years: Includes vomiting and severe headache
- •Different LOC thresholds by age group
- •All groups: GCS, skull fracture, altered mental state
Clinical Implementation
PECARN rules should be integrated with clinical judgment, family preferences, and institutional protocols. They provide guidance but do not replace comprehensive clinical assessment.
Limitations
Important: PECARN rules apply only to children with head trauma presenting within 24 hours of injury and do not replace clinical judgment for patients with penetrating injuries or pre-existing neurological disorders.
Critical Medical Disclaimer
This calculator is for educational purposes only and should never replace professional medical evaluation. Pediatric head injuries require careful clinical assessment by qualified healthcare professionals. The PECARN rules are decision support tools that must be used in conjunction with clinical judgment, patient/family preferences, and institutional protocols. Always seek immediate medical attention for any child with a significant head injury. This tool should only be used by trained healthcare professionals familiar with pediatric emergency medicine.