This week, PECARN published a study that determined that isolated loss of consciousness (LOC) is not a strong enough predictive factor for a clinically significant traumatic brain injury, which they define as requiring intubation, extended inpatient observation, and/or neurosurgical intervention (rate of 0.5% (95% CI, 0.2-0.8; 13 of 2780). The rate is slightly higher for children younger than 2 years old than for those 2 or older.
Therefore, their updated recommendation is to NOT do a head CT in pediatric patients who present with isolated LOC after head trauma and none of the other PECARN predictors.
PECARN, a multi-institutional research organization, has a database of over 60,000 pediatric patients and has published over 60 peer-reviewed articles in pediatric emergency medicine.
The 2009 PECARN decision rule for head CT after head trauma is as follows (A is for patients younger than 2 years old, B is for patients 2 years or older):
JAMA Pediatr. 2014 Jul 7. doi: 10.1001/jamapediatrics.2014.361
Lancet. 2009 Oct 3;374(9696):1160-70. doi: 10.1016/S0140-6736(09)61558-0. Epub 2009 Sep 14.