TBI in Children

Traumatic Brain Injury

Pecarn rule does not apply to:

  • Neuro background e.g.
    • VP shunt
    • Known brain tumour
    • Neurological condition

Pecarn rule does not apply to:

  • Penetrating trauma
  • Bleeding disorder


Prediction rules for Traumatic Brain Injury

Age < 2 years Age ≥ 2 years
Altered mental status ‡ Altered mental status ‡
Severe mechanism of Injury * Severe mechanism of Injury *
Loss of consciousness ≥5 seconds Any loss of consciousness
Palpable skull fracture Signs of basilar skull fracture
Non-frontal scalp haematoma History of vomiting
Abnormal behaviour Severe headache

Children with no clinical factors are classified as "low risk".

‡ GCS 14, agitation, sleepiness, slow response or repetitive questioning.

* Motor vehicle crash with patient ejection, death of another passenger or "rollover", pedestrian or cyclist without helmet struck by vehicle, fall (>1m for children <2yrs; >1.5M for children ≥2 yrs), or head struck by "high-impact" object.

In those requiring imaging, consider CT cervical spine (after discussion with your senior in all cases).


For those undergoing neurological observations, please use the WPTAS (patients ≥7 years).

Content by Dr Íomhar O' Sullivan. Last review Dr ÍOS 16/06/21.