From the Guidelines
The PECARN scoring system is a clinical decision tool that helps identify children at very low risk of clinically important traumatic brain injuries after head trauma, and it is the most widely validated criteria, particularly for very young children, with a 100% negative predictive value and sensitivity in children under 2 years of age, as demonstrated in a large prospective trial in Australia and New Zealand 1. The PECARN criteria assess different factors for children under 2 years and those 2 years and older. For children younger than 2 years, the criteria include altered mental status, non-frontal scalp hematoma, loss of consciousness for 5 seconds or more, severe injury mechanism, palpable skull fracture, and not acting normally according to parents. For children 2 years and older, the criteria include altered mental status, any loss of consciousness, vomiting, severe headache, signs of basilar skull fracture, and severe injury mechanism.
- The criteria are used to stratify children into very low, intermediate, and relatively high risk for clinically important acute traumatic brain injury in the setting of minor blunt head trauma.
- If none of the risk factors are present, the risk of clinically important traumatic brain injury is less than 0.1%, and CT scans can generally be avoided, reducing unnecessary radiation exposure in children.
- The PECARN criteria have been incorporated into clinical guidelines for acute minor pediatric head trauma imaging and have been shown to be more sensitive than other clinical decision rules, such as the CATCH and CHALICE criteria 1.
- The use of the PECARN scoring system can help clinicians make informed decisions about which children need imaging and which can be safely observed, ultimately improving patient outcomes and reducing unnecessary radiation exposure.
From the Research
Overview of the PECARN Scoring System
The Pediatric Emergency Care Applied Research Network (PECARN) scoring system is a clinical prediction rule used to identify children at very low risk of a significant head injury who can safely avoid computed tomography (CT) scans 2, 3, 4, 5, 6.
Key Components of the PECARN Scoring System
- The PECARN traumatic brain injury (TBI) age-based clinical prediction rules identify children at very low risk of a significant head injury who can safely avoid CT scans 2.
- The rules are based on the presence or absence of variables such as age, mechanism of injury, and clinical findings 4.
- The PECARN rule is divided into two age groups: children under 2 years and children 2 years and older 3, 5.
Validation and Effectiveness of the PECARN Scoring System
- Studies have validated the PECARN rule, demonstrating its high sensitivity and negative predictive value for identifying children at low risk of clinically important TBI 2, 3, 5.
- The PECARN rule has been shown to be effective in reducing the number of CT scans performed on children with minor head trauma, without missing any cases of clinically important TBI 5, 6.
- The rule has also been found to be cost-effective, reducing healthcare costs and radiation exposure while maintaining high sensitivity for detecting clinically important TBI 4.
Clinical Applications of the PECARN Scoring System
- The PECARN rule can be used to assist in CT decision making for children with minor blunt head trauma 2.
- Clinicians can use the rule to identify children at very low risk of clinically important TBI, who can safely avoid CT scans and reduce their exposure to ionizing radiation 3, 5, 6.
- The rule can also be used to reduce CT utilization rates in pediatric patients presenting with minor blunt head injuries 6.