I think it’s amazing that the Pediatric Emergency Care Applied Research Network has been turned into a verb. As in, “I PEACARN’ed that kid with the head injury and we don’t need a CT.” This is one of the most widely used tools in our arsenal when caring for injured children in the ED and I find that is exceedingly helpful to either review the MD Calc version of the decision tool…
…And/or the amazing infographics created by the folks at Academic Life in Emergency Medicine. I’ve embedded links to the pdfs for each below.
Remember that this tool was derived through a rigorous multi-site study and extensively validated. And that the decision as to whether or not to get a CT is to help identify clinically important traumatic brain injuries, which are injuries that require one or more of the following;
- Neurosurgical intervention
- Admission to the ICU
- Admission to the hospital >2 days
- Intubation
Note that this decision rule doesn’t help you identify “bleeding on the brain,” or “concussion” – it is based on what serious injuries lead to. This is subtle but important. You are willing to miss a small non space occupying bleed or a nondisplaced skull fracture since they won’t require any of the above if you elect to not get a CT.
References / More Reading
Kuppermann N, Holmes J, Dayan P, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160-1170.
Sudario, G. PECARN Pediatric Head Trauma: Official Visual Decision Aid for Clinicians. Academic Life in Emergency Medicine. https://www.aliem.com/pecarn-pediatric-head-trauma-official-visual-decision-aid/. June 27, 2017. Accessed January 10, 2022.
