Calculators · Paediatrics & Neonatology · Criteria

PECARN paediatric head trauma rule (<2 y and ≥2 y)

Also called PECARN head CT rule, pediatric head injury CT decision, Kuppermann rule

Identifies children with minor blunt head trauma (GCS 14–15, within 24 h) at very low risk of clinically important brain injury, in whom CT can be avoided.

Age group

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Formula and scoring

<2 y — high: GCS 14/AMS or palpable skull fracture; intermediate: non-frontal scalp haematoma, LOC ≥5 s, severe mechanism, not acting normally per parent. ≥2 y — high: GCS 14/AMS or signs of basilar skull fracture; intermediate: any LOC, vomiting, severe mechanism, severe headache. No predictor = very low risk.

Exam and ward pearls

  • ciTBI = death from TBI, neurosurgery, intubation >24 h, or hospital admission ≥2 nights for the TBI.
  • Derived and validated in 42,412 children at 25 North American EDs — the largest paediatric head-injury cohort.
  • Severe-mechanism fall height differs by age: >3 ft (<2 y) versus >5 ft (≥2 y).

When not to rely on it

  • Only for children under 18 years seen within 24 hours of head trauma with GCS 14–15; not for GCS 13 or below.
  • Suspected non-accidental injury needs its own pathway regardless of the PECARN result.

Source

  1. 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):1160-70. doi:10.1016/S0140-6736(09)61558-0 · PMID 19758692

Formula and cut-offs checked against these sources on 8 Nov 2026. Educational tool for clinicians; it does not replace clinical judgement.

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