The PECARN Pediatric Head CT Rule Project | An Insider’s Take!

In Infographics, Medical Concepts by Alvin ChinLeave a Comment

Editor’s Note: Everyone loves a great super hero origin story! And so we bring you the backstory behind the joint PECARN-ALiEM-CanadiEM knowledge translation project. Hope you enjoy both the story and, more importantly, the infographics! – TC

In the pediatric population, traumatic brain injury (TBI) is amongst the most common reason for presentation to an emergency department.  TBI accounts for nearly 50,000 of the visits of children to an emergency department every year in Canada[1].

One popular clinical decision tool is the PECARN Pediatric Head Injury Prediction Rule [2].  This tool is used to guide physicians in determining which children need to be exposed to the harmful radiation of a CT scan versus those that we can safely discharge home without one.

While this tool has been commonly accepted as a very useful due to its high sensitivity in detecting patients with clinically important TBIs, a drawback is the multiple components of the tool required to obtain a decision.

Six months ago, Gabe Sudario, an Emergency Medicine resident at Zuckerberg San Francisco General Hospital, University of California, gathered an international, multi-team workgroup in order to create a visual tool to:

  1. Simplify the algorithm for users
  2. Serve as a reminder for users who have familiarity with the study.
  3. Be used a reference tool for a multi-disciplinary team to come to clinical decisions in the resuscitation area.

Three teams were formed amongst the international working group and each team drafted a design for this purpose.  Through the Slack platform, the group collaborated to take analyze the most functional and useful part of each design in order to create and refine a final product.

Figure 1.  Some of the initial design drafts that contributed to the final product.

And now… We present the Final Product!

Over the course of six months, we continued to modify the design until we came up with the official PECARN head trauma, visual decision rule aid.  Enjoy.

Download the new PECARN Pediatric Head CT Rule cards by clicking the buttons below!

A big shout out to Gabe Sudario who came up with this initiative and gathered an international team to collaborate on this project.  Also, thank you to everyone involved in the design process. 

Credits go to:

Primary Design Team:

  • Beth Runcie, DO, PGY-4, UH Regional Hospitals Emergency Medicine
  • Esther Chen, MD, Professor of Emergency Medicine, Zuckerberg San Francisco General Hospital
  • Alvin Chin, MD, MSc, PGY-1, McMaster University Emergency Medicine

Digital Innovation Team

  • Teresa Chan, Assistant Professor, McMaster University, Division of Emergency Medicine, Department of Medicine
  • Scott Kobner MD (Candidate), Medical Student, NYU
  • Nathan Kuppermann, MD, Professor, Emergency Medicine and Pediatrics, UC Davis Department of Emergency Medicine, Principal Investigator – Pediatric Emergency Care Applied Research Network (PECARN)
  • Michelle Lin, MD, Professor of Emergency Medicine, Zuckerberg San Francisco General Hospital
  • Simon Huang, MD (Candidate), MS2, University of Saskatchewan, College of Medicine
  • Warren Wiechmann, MD, Associate Dean, Clinical Science Education and Educational Technology, UC Irvine School of Medicine


  1. Canadian Traumatic Brain Injury Research Consortium. (n.d.). Retrieved June 14, 2017, from
  2. Kuppermann, N., Holmes, J. F., Dayan, P. S., Hoyle, J. D., Atabaki, S. M., Holubkov, R., … & Badawy, M. K. (2009). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. The Lancet, 374(9696), 1160-1170.
Alvin is currently a PGY5 in the FRCP EM program at McMaster University. He serves as Director of Design for CanadiEM and has interests in knowledge translation and health innovation.