1. Paediatric Head Injury – To CT or not CT?
Slides taken from:
Advanced Paediatric Life Support
Presentation created and presented by:
Dr Setthy Ung
APLS Australia Course Director

2. Head Injury – To CT or not CT?
Babl et al. Lancet 2017
0-18yrs, <24hrs, 18,913 patients
PREDICT EDs across Australia
For clinically important Traumatic Brain Injury
PECARN
< 2yrs - Sens 100% Spec 59.1%
> 2yrs - Sens 99.2% Spec 52%
CATCH - Sens 91.9% Spec 70.4%
CHALICE – Sens 92.5% Spec 78.6%

3. PECARN < 2yrs High Risk (4.3%) indicating CT scanning
GCS 14
Or other signs of altered mental status
Or Palpable skull fracture (<2yrs)
Lower Risk (0.9%) to then consider observation over CT scanning
Scalp haematoma (occipital, temporal or parietal)
Loss of consciousness > 5secs
Severe mechanism of injury
Not acting normally according to parent
All above negative gave < 0.02% risk
Other clinical factors:
Physician experience
Multiple concomitant factors
Worsening signs and symptoms
Parental Preference

4. PECARN > 2yrs High Risk (4.4%) indicating CT scanning
GCS 14
Or other Signs of altered mental status
Or Signs of Base of Skull fracture
Lower Risk (0.8%) to then consider observation over CT scanning
History of LOC
History of vomiting
Severe mechanism of injury
Severe headache
All above negative gave < 0.05% risk
Other clinical factors:
Physician experience
Multiple concomitant factors
Worsening signs and symptoms
Parental Preference