Adapted PECARN Head Injury Rule Is Safe and Effective

In an observational before–after study at a tertiary pediatric emergency department in Italy, investigators evaluated adapted Pediatric Emergency Care Applied Research Network (PECARN) head injury rules for children younger than 15 years (see table). Before implementation, patients were risk-stratified according to a previously established protocol that differed from the PECARN rules by including presence of Glasgow Coma Scale score ≤12 or a two-point drop in score since arrival, focal neurological signs, or loss of consciousness for more than 5 minutes. The PECARN rules were adapted by inclusion of amnesia and more than five episodes or 6 hours of vomiting for patients <2 years of age; for all patients, those not undergoing head computed t…