Paediatric Head Injury CT Stratification

NICE NG232 (supersedes CG176) and PECARN decision support for children

Patient Age

Age (years)

Additional months

Age drives age-specific NICE criteria (<1 year) and PECARN branch (<2 years vs >=2 years).

Enter age to activate age-specific criteria.

NICE NG232 Checklist (under 16 years)

Immediate CT criteria trigger CT head within 1 hour. Secondary factors guide observation and re-assessment.

Immediate CT criteria (scan within 1 hour if any)

Suspicion of non-accidental injury Post-traumatic seizure (no epilepsy history) Initial GCS <14 For age <1 year: initial GCS <15 GCS <15 at 2 hours after injury Suspected open/depressed skull fracture or tense fontanelle Any sign of basal skull fracture Focal neurological deficit For age <1 year: bruise/swelling/laceration on head >5 cm

Secondary risk factors (observation pathway if no immediate criteria)

Loss of consciousness lasting >5 minutes Abnormal drowsiness Three or more discrete vomiting episodes Dangerous mechanism of injury Amnesia (antegrade or retrograde) lasting >5 minutes Known bleeding/clotting disorder

PECARN Checklist

Only the age-appropriate PECARN rule is used for classification.

PECARN for age <2 years

GCS <=14 or altered mental status Palpable skull fracture Occipital/parietal/temporal scalp hematoma Loss of consciousness >=5 seconds Not acting normally per parent Severe mechanism of injury

PECARN for age >=2 years

GCS <=14 or altered mental status Signs of basilar skull fracture Any history of loss of consciousness History of vomiting Severe headache Severe mechanism of injury

PECARN severe mechanism definition: MVC with ejection, death of another passenger, or rollover; pedestrian/cyclist without helmet struck by vehicle; fall >0.9 m (<2y) or >1.5 m (>=2y); or head struck by high-impact object.

Recommendation Output

NICE NG232 recommendation

Enter age and tick factors to generate an output.

PECARN recommendation

Enter age and tick factors to generate an output.

Clinical decision support only. NICE branch uses NG232 (superseding CG176). Always apply local protocol and senior clinical judgement.