Discharge Instructions - Pediatric Head Injury (PECARN Recommendations)

As discussed in the Emergency Department prior to discharge, based on the mechanism of injury and your child’s exam and applying the PECARN Pediatric Head Injury Prediction Rule, it was felt your child had a very low risk of clinically important traumatic brain injury (ciTBI).

The PECARN rule is based on the largest study to date aiming to develop a clinical decision rule to identify children with head injury who are at very low risk for having an injury to the brain that would require more significant treatment.  This is important because computed tomography (or CT) scans expose patients to radiation, which can increase the long-term risk of cancer.  This concern over exposure to radiation is especially important in young children.  The PECARN study involved over 40,000 children under the age of 18, and has been validated in subsequent 2 studies.

As discussed prior to discharge, when this rule was applied to your child they were noted to have a risk of clinically important traumatic brain injury (ciTBI) of [<0.02/0.9/##]%. Given this [very low risk] risk, PECARN recommended [not getting a CT at this time and observing the child for development of signs concerning for ciTBI/obtaining CT, which was ultimately without evidence of ciTBI].

Return to the Emergency Department immediately should your child develop confusion, appear more drowsy, lethargic, or difficult to arouse, vomiting (especially repetitive episodes or unprovoked episodes, as in those not occurring in the setting of feeding), difficulty walking in children who are old enough, or any new or concerning symptoms.

It is important to allow your child to rest.  It is not uncommon for children with minor head injuries to want to nap or sleep early than usual.  It is not necessary to try to keep your child awake.  It is reasonable to keep your children from particularly strenuous activities for 24-48 hours.  If your child participated in physical education (PE) classes or sports you should notify the school and/or coach, and your child should not return to these activities for at least 24 hours from the time of injury.  Your child should not return to PE class or sports until they are without symptoms with normal activity.  If your child is still experiencing headaches after 3 days, you should have them evaluated by their primary care provider.

https://www.mdcalc.com/pecarn-pediatric-head-injury-trauma-algorithm
https://www.aliem.com/pecarn-pediatric-head-trauma-official-visual-decision-aid/