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Between 20% and 60% of children presenting to EDs with head injury undergo head CT in the U.S., even though less than 1% of children with GCS of 14 – 15 have an injury that requires any kind of intervention. Using the PECARN head injury prediction rule can significantly improve the value we deliver to our patients by reducing unnecessary CT scans in children, thereby reducing radiation exposure and decreasing costs.

California ACEP has developed a toolkit to facilitate adoption of the evidence-based PECARN algorithm. The toolkit specifically addresses “shared decision making” as a vital part of PECARN, and spells out how observation can be a safe alternative to CT scanning in low-risk patients. We encourage all emergency providers to utilize the California ACEP PECARN toolkit so all pediatric patients with minor head injuries can benefit from the landmark PECARN study.

PECARN Decision Guides


California ACEP has developed pocket reference cards that summarize the decision rule.  We are pleased to offer you this toolkit in hopes that it will enhance your practice and prove useful to you.
PECARN Pocket Card: Under 2 Years Old
PECARN Pocket Card: Over 2 Years Old

Communicating PECARN
We have included resources for you to communicate the guidelines to patients, hospital staff, and local pediatricians. Included in this section is a letter you can use to bring medical staff and local physicians on board with the safe prescribing guidelines, in addition to suggestions for how to communicate the guides to parents.
Communicating Guidelines to Patients

Communicating Guidelines to Colleagues
PECARN Sample Primary Care Provider Letter 


Identification of Children at Very Low Risk of Clinically-Important Brain Injuries after Head Trauma: A Prospective Cohort Study (2009)
Risk of Traumatic Brain Injuries in Children Younger than 24 Months with Isolated Scalp Hematomas 2014
Computed Tomography for Minor Head Injury – Variation and Trends in Major United States Pediatric Emergency Departments (2012)
The Use of Computed Tomography in Pediatrics and the Associated Radiation Exposure and Estimated Cancer Risk (2013)
Traumatic Brain Injury in the United States – Emergency Department Visits, Hospitalizations and Deaths 2002-2006 (2010)
The Effect of Observation on Cranial Computed Tomography Utilization for Children after Blunt Head Trauma (2011)
A Decision Rule for Identifying Children at Low Risk for Brain Injuries after Blunt Head Trauma (2003)
Computed Tomography – An Increasing Source of Radiation Exposure (2007)
Estimating Cancer Risks from Pediatric CT – Going from the Qualitative to the Quantitative (2002)

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Chi L. PerlrothMeet California ACEP's Immediate Past President Dr. Chi Perlroth!
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