Clinical Trials

Inclusion Criteria:

Parents and their child, seeking care for a child who:

1. Is < 18 years of age;
2. Had blunt trauma above the eyebrows (not isolated to face or eyes);
3. Is positive for at least 1 of the PECARN clinical prediction rule predictors described below:
   • PECARN Predictors for children < 2 years of age:
     • Severe mechanism (PECARN definition)*
     • Loss of consciousness > 5 seconds
     • Acting abnormally per parent
     • Initial ED GCS < 15 by attending (or CT decision-maker)
     • Other signs of altered mental status (PECARN definition)
     • Presence of occipital, temporal or parietal scalp hematoma
     • Palpable skull fracture or unclear if skull fracture
   • PECARN predictors for children 2-18 years of age:
     • Severe mechanism (PECARN definition)*
     • Any loss of consciousness
     • Any vomiting since the injury
     • Severe headache in ED
     • Initial ED GCS < 15 by attending (or CT decision-maker)
     • Other signs of altered mental status (PECARN definition)**
     • Any sign of basilar skull fracture

Clinicians include attending physicians and fellows or midlevel providers caring for children with head trauma

Exclusion Criteria:

Parents of children with:

1. Palpable/unclear skull fracture or signs of basilar skull fracture on physical examination
2. Penetrating trauma (e.g., gunshot, stab)
3. GCS score < 14 or other signs of altered mental status (PECARN definition)
4. > 24 hours since the injury
5. Brain tumors
6. Ventricular shunts
7. Bleeding disorder
8. Pre-existing neurological disorders complicating assessment
9. Syncope or seizure that preceded (led to) head trauma
10. Patient known to be pregnant
11. Neuroimaging at an outside hospital before transfer
12. Patient has 3 or more PECARN risk factors
13. Parent(s) have, in their clinician's best judgment, communication barriers such as visual or hearing impairment that preclude use of the decision aid