Background: Minor head trauma is one of the leading causes of accessing pediatric
emergency departments; however, only a limited number of patients develops clinically relevant
Objectives: The aim of this review is to provide physicians a clinical pathway for managing pediatric
minor head trauma.
Methods: A Pubmed/Medline search was conducted through the following entries: “minor head
trauma”, “mild head trauma”, “minor head injury”, “mild head injury” or “acute head trauma”. All
the studies including pediatric samples between 2000 and 2015 were considered for a critical review.
A few articles written before 2000 were analyzed for their relevance.
Results: The Pediatric Emergency Care Applied Research Network (PECARN) algorithm identified
children with a very low risk for clinically relevant brain injuries (normal mental status, no loss of
consciousness, no vomiting, non-severe injury mechanism, no signs of basilar skull fracture, no severe
headache, no evident clinical worsening over time and no multiple symptoms) and offered the
only validated clinical prediction rule to select candidates for CT scans. Other proposed clinical prediction
rules (including NEXUS II, CHALICE and CATCH), that were not validated, have a lower
sensitivity than PECARN algorithm.
Skull X-ray, cerebral magnetic resonance and cranial ultrasonography could provide useful information
in selected cases.
Conclusions: The critical use of PECARN rule represents the best validated clinical tool for the
early identification of children with a clinically relevant brain injury. Its application should be integrated
with physician experience and judgement, parental compliance and clinical observation.