PECARN Pediatric Head Injury Decision Rule
Identifies children at very low risk for clinically important traumatic brain injury to reduce unnecessary CT scans
- Highest activation tier
- Mandatory
- How it is scored
- Scored in code; a stated value is compared only from the structured summary or a supplied value
- Scoring type
- classification
- Care settings
- Emergency department
When it activates
Scribeable activates a calculator from the encounter. The PECARN Pediatric Head Injury Decision Rule can activate when the transcript or pasted chart context documents any of these:
- Pediatric head injury evaluation
- Child head trauma assessment
- Pediatric concussion evaluation
- CT decision in pediatric head injury
- Pediatric fall with head impact
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: S06.
Inputs the note needs
8 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; an input marked "asks you" is requested as a clarification when it is undocumented.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| Age group: <2 years or 2-18 years | age | ||
| GCS score | exam | ||
| Altered mental status (agitation, somnolence, repetitive questioning, slow response) | exam | ||
| Palpable skull fracture (<2y) or signs of basilar skull fracture (2-18y) | exam | ||
| Occipital, parietal, or temporal scalp hematoma (<2y) / loss of consciousness (2-18y) | exam | ||
| Loss of consciousness ≥5 sec (<2y) / vomiting (2-18y) | symptom | ||
| Severe mechanism of injury (MVC with ejection/rollover/fatality, bicycle vs car, fall >3ft <2y or >5ft 2-18y, head struck by high-impact object) | history | ||
| Not acting normally per parent (<2y) / severe headache (2-18y) | symptom |
Scoring
<2 years: High risk if GCS <15, altered mental status, or palpable skull fracture → CT. Intermediate if occipital/parietal/temporal hematoma, LOC ≥5s, severe mechanism, or not acting normally → observation vs CT. 2-18 years: High risk if GCS <15, altered mental status, or basilar skull fracture signs → CT. Intermediate if LOC, vomiting, severe mechanism, or severe headache → observation vs CT. Score: 0 = very low risk (no CT), 1 = intermediate risk (observation vs CT), 2 = high risk (CT recommended).
Interpretation
High risk (any): CT recommended. ciTBI risk >4%. Intermediate risk: Observation vs CT based on clinical judgment, physician experience, worsening symptoms, parental preference. ciTBI risk ~1%. Very low risk (no predictors): CT not recommended. ciTBI risk <0.05% (<2y) or <0.02% (2-18y). Negative predictive value 99.95-100%.
Evidence
Sources carried in Scribeable's citation registry for this calculator; guideline version: Kuppermann N et al. 2009.
- Kuppermann N et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study (PECARN)Kuppermann et al. (PECARN) 2009 · 2009 · PECARN · Level I · link last verified 2026-03-28
How Scribeable handles it in the note
When an encounter activates the PECARN Pediatric Head Injury Decision Rule at the mandatory tier, Scribeable resolves its inputs from the transcript, the pasted chart context and any charted labs, and asks you for a missing input you can supply before the note is finalised. Bedside-exam and separately ordered study values are not requested one input at a time; a calculator that carries a combined clarification question may still put that single question to you.
The score is computed in code from the resolved inputs, not recalled by the language model. A stated PECARN Pediatric Head Injury Decision Rule value is compared against the computed one when the draft's structured summary carries it; a disagreement found there is flagged to the second drafting pass, which is instructed to correct the score and its interpretation, unless Scribeable has supplied the computed value to that pass, in which case the value the draft writes is checked against the supplied one and a detected difference is shown beside the note for you to adjudicate rather than silently rewritten.
Classified as a mandatory rule-out score: a missed result carries acute harm, so the activation filter never approves it on uncertainty.
See it activate on your own encounter
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