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| 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?
- Does the 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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