Children < 18 years with GCS 14–15 within 24 h of head trauma
Age
Younger than 2 years
2 years or older
GCS 14 or other signs of altered mental status (agitation, somnolence, repetitive questioning, slow response)
Signs of basilar skull fracture
Any history of loss of consciousness
Vomiting
Severe mechanism of injury
Severe headache
Severe mechanism: motor-vehicle crash with ejection, death of another passenger or rollover; pedestrian or unhelmeted cyclist struck by a motorised vehicle; fall from > 1.5 m (5 ft); or head struck by a high-impact object.
Evidence
Original publication
Kuppermann N, Holmes JF, Dayan PS, et al.; PECARN. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. 42 412 children < 18 years with GCS 14–15 within 24 h of head trauma. In validation, the rule for < 2 years had a negative predictive value of 100% (1176/1176) and sensitivity of 100% (25/25); for ≥ 2 years, 99.95% (3798/3800) and 96.8% (61/63).
Lancet, 2009
Open source
Last reviewed: 2026-09
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