PECARN Head Injury (≥ 2y) Calculator

PECARN Head Injury (≥ 2y) Calculator for Pediatrics. Higher concern is assigned for GCS 14, other altered mental status or the age-specific skull-fracture finding. The intermediate findings are any loss of consciousness, vomiting, severe mechanism, or severe headache. A very-low-risk branch can support avoiding CT in an appropriate assessment, but is not an automatic discharge decision.

For shared guidance on choosing a tool and documenting results, read the clinical calculator workflow.

How this calculator works

This page implements the age-specific PECARN decision branches for children aged two through 17 years. It does not add predictors into a numeric score. The assessment requires a compatible age, GCS 14 or 15, presentation within 24 hours, an eligible nontrivial blunt injury and explicit responses to every finding.

When to use this calculator

Use only in a reliable assessment of the population represented by the original minor-head-injury study. Penetrating injury, a ventricular shunt, bleeding disorder, a neurologic condition that confounds assessment or suspected abuse needs a separate clinical pathway. The calculator cannot adjudicate those exclusions.

Inputs used

  • Age (months)
  • Time since injury (hours)
  • Assessed GCS total
  • Eligible nontrivial blunt injury with a reliable assessment?
  • Other altered mental status present?
  • Signs of basilar skull fracture present?
  • Any loss of consciousness?
  • Severe injury mechanism?
  • Vomiting after injury?
  • Severe headache?

Clinical interpretation

Higher concern is assigned for GCS 14, other altered mental status or the age-specific skull-fracture finding. The intermediate findings are any loss of consciousness, vomiting, severe mechanism, or severe headache. A very-low-risk branch can support avoiding CT in an appropriate assessment, but is not an automatic discharge decision.

Worked example

For an eligible child with GCS 15 and no listed findings, the output is the very-low-risk branch. One intermediate finding changes the output to the observation-versus-CT branch. GCS 14 or a high-risk fracture or mental-status finding takes precedence. Leaving even one required intermediate response blank produces no result.

Limitations and safety notes

The tool cannot verify an examination, reliably distinguish every injury mechanism or assess clinical deterioration. Observation versus CT requires clinical judgment and discussion. The form applies the rule hierarchy without reproducing an individual risk percentage; younger infants and changing findings need particular caution.

Frequently asked questions

Is an unchecked finding assumed absent?

No. Every clinical finding requires an explicit response before a branch is returned.

Does an intermediate finding automatically require CT?

No. Observation versus imaging depends on clinical judgment, evolution and the full assessment.

Is this a numeric PECARN score?

No. High-risk findings take precedence over intermediate findings in an age-specific decision rule.

References

  • Original2009 minor blunt head-trauma cohort, GCS14-15, within24h, age-specific high/intermediate predictor hierarchy and applicability restrictions. https://pecarn.org/studyDatasets/documents/Kuppermann_2009_The-Lancet_000.pdf

Editorial review and citation methodology

Maintained by the Quick Medical Calculator Editorial Team. Content record date: September 9, 2026. A content date is not evidence of independent clinical review. Individual clinical sign-off is not recorded on this page.

  • Prefer original validation studies for scoring systems and prediction tools.
  • Use current specialty society guidance, transplant allocation policy, public health guidance, or regulator resources when they govern clinical use.
  • Include limitations and safety notes when a calculator is population-specific, context-dependent, or unsuitable as a standalone decision tool.

Related reviewed calculators