Calculators & Tools

PECARN Head Injury — Age < 2 years

Identifies children under 2 at very low risk of clinically-important traumatic brain injury (ciTBI).

1 What is the PECARN Head Injury — Age < 2 years?

The PECARN Head Injury — Age < 2 years is a Neurology & trauma scoring tool used in paediatric practice. Identifies children under 2 at very low risk of clinically-important traumatic brain injury (ciTBI). It scores 5 criteria and interprets the total across 3 bands, so the number always arrives with the severity it implies rather than on its own. In PediAid each criterion is shown as a labelled option with the weight it carries, so the total can be checked rather than taken on trust.

2 When to use it

  • Grading severity at the bedside in Neurology & trauma
  • Recording an objective severity band in the case notes
  • Deciding when a total crosses the threshold for escalation
  • Re-scoring to track whether a child is improving or deteriorating
  • Checking the exact criteria of a score used infrequently

3 Formula & method

The score sums 5 criteria: GCS ≤ 14, altered mental status, or palpable skull fracture; Occipital, parietal or temporal scalp haematoma; Loss of consciousness ≥ 5 seconds; Severe mechanism of injury; Not acting normally according to the parent. Totals are then banded: any score - CT not recommended: no predictors - risk of ciTBI <0.02%. CT is not recommended; discharge with head-injury advice is appropriate; 1 predictor or more - Observation vs CT: intermediate group - ciTBI risk ≈0.9%. Observation in the emergency department is preferred; CT if multiple findings, worsening symptoms, age <3 months, or parental preference; 8 predictors or more - CT recommended: gCS ≤14, altered mental status or palpable skull fracture - ciTBI risk ≈4.4%. CT head is recommended.
  • Severe mechanism: MVC with ejection/rollover/death of another passenger; pedestrian or cyclist without helmet struck by a vehicle; fall >0.9 m (3 ft) under 2 years; head struck by a high-impact object.
  • Source: Kuppermann N et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study (PECARN). Lancet 2009;374:1160-70.

4 Frequently asked questions

How many criteria does the PECARN Head Injury — Age < 2 years use?

5. They are GCS ≤ 14, altered mental status, or palpable skull fracture; Occipital, parietal or temporal scalp haematoma; Loss of consciousness ≥ 5 seconds; Severe mechanism of injury; Not acting normally according to the parent.

What do the bands of the PECARN Head Injury — Age < 2 years mean?

The total is interpreted as: any score - CT not recommended: no predictors - risk of ciTBI <0.02%. CT is not recommended; discharge with head-injury advice is appropriate; 1 predictor or more - Observation vs CT: intermediate group - ciTBI risk ≈0.9%. Observation in the emergency department is preferred; CT if multiple findings, worsening symptoms, age <3 months, or parental preference; 8 predictors or more - CT recommended: gCS ≤14, altered mental status or palpable skull fracture - ciTBI risk ≈4.4%. CT head is recommended.

Does the score replace clinical judgement?

No. It is a structured way to record and communicate severity. A clinician concerned about a child should act on that concern regardless of the total.

Where does this score come from?

Severe mechanism: MVC with ejection/rollover/death of another passenger; pedestrian or cyclist without helmet struck by a vehicle; fall >0.9 m (3 ft) under 2 years; head struck by a high-impact object.

Does it work offline?

Yes. Score definitions are bundled with the PediAid app, so the score computes without a connection.

For qualified clinicians. This page and the PediAid app are a clinical aid only. Calculations and reference data must be verified against the patient's clinical context, the source guideline and your local protocols before any treatment decision is made.