Palchak (UC Davis) Rule for Pediatric Head Trauma

Identifies children at very low risk for clinically important brain injury after blunt head trauma.

Abnormal mental status

Clinical signs of skull fracture

History of vomiting

Scalp hematoma (especially if age <=2 years)

Headache

ResultLow risk

None of the five predictors are present - very low risk of clinically important traumatic brain injury; CT can usually be safely deferred.

Predictors present: 0

When to use

Children presenting after blunt head trauma being considered for cranial CT to detect clinically important brain injury.

Formula

Low risk if none of the following are present: abnormal mental status, clinical signs of skull fracture, history of vomiting, scalp hematoma (particularly age <=2y), or headache.

Pearls and pitfalls

Derived and validated at UC Davis; sensitivity for clinically important TBI was ~99-100% in the derivation/validation cohorts.
Largely superseded in practice by PECARN, but historically important as one of the first pediatric head-injury decision rules.

References

Palchak MJ, et al. A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Ann Emerg Med. 2003;42(4):492-506.