# Drag each finding for a child younger than 2 years with minor blunt head trauma to the PECARN risk pathway it supports.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=393525&lang=en  
> language: en  
> subject: Diagnostic Tests  
> category: ROR

## Question

Drag each finding for a child younger than 2 years with minor blunt head trauma to the PECARN risk pathway it supports.

**1.** 15-month-old with a palpable skull fracture

Select a category
High-risk CT pathway
Observation versus CT pathway
Very low risk; CT generally not indicated

**2.** 18-month-old with GCS 14 and persistent somnolence after minor blunt trauma

Select a category
High-risk CT pathway
Observation versus CT pathway
Very low risk; CT generally not indicated

**3.** 14-month-old with an occipital scalp hematoma and otherwise normal examination

Select a category
High-risk CT pathway
Observation versus CT pathway
Very low risk; CT generally not indicated

**4.** 20-month-old who walked into a doorframe and has none of the PECARN predictors

Select a category
High-risk CT pathway
Observation versus CT pathway
Very low risk; CT generally not indicated

**5.** 6-month-old who fell 1.2 m, had brief loss of consciousness, and is now alert

Select a category
High-risk CT pathway
Observation versus CT pathway
Very low risk; CT generally not indicated

## Explanation

For children younger than 2 years, altered mental status or a palpable skull fracture places the child in the high-risk CT pathway. A nonfrontal scalp hematoma, loss of consciousness for at least 5 seconds, severe mechanism, or caregiver report that the child is not acting normally supports observation versus CT. Absence of all rule predictors supports the very-low-risk pathway in which CT is generally unnecessary.

## In-depth explanation

Quick answer
Altered mental status or palpable skull fracture = high risk; isolated nonfrontal hematoma, qualifying loss of consciousness, severe mechanism, or abnormal behavior = observation versus CT; no predictors = very low risk.

Why this is correct
The PECARN prospective cohort derived and validated age-specific prediction rules for clinically important traumatic brain injury. It is intended to identify children at very low risk and reduce unnecessary radiation, not to authorize an automatic nursing CT order.

NCLEX decision rule
First confirm that the child fits the rule population and age band. Then identify high-risk cues, maintain neurologic observation, and escalate any deterioration or new finding.Reference
1Kuppermann et al., PECARN head-trauma prediction ruleThe Lancet, 2009 prospective cohort

## Clinical scenario

Diagnostic decision support
The nurse recognizes risk cues, maintains observation, and communicates changes; the prescribing clinician makes the CT decision using the full clinical context. The PECARN rule applies to the studied minor-head-trauma population and does not replace judgment.

## Key concepts

- **Clinically Important TBI** — A traumatic brain injury outcome defined by death, neurosurgery, prolonged intubation, or hospital admission of at least two nights for the head injury.
- **Severe Mechanism** — A higher-energy injury mechanism defined by the age-specific PECARN rule, such as a substantial fall or high-impact object.
- **basilar skull fracture** — Battle sign, raccoon eyes, hemotympanum, CSF leak indicate skull base fracture.

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