ERcast: Clinical Perspectives Podcast Preview
The summary below is from an episode of ERcast: Clinical Perspectives
PECARN performs differently in infants younger than 3 months with minor blunt head trauma: it is very good at identifying very low risk for clinically important TBI, but not for every CT-visible injury. In this age group, the key decision is whether you are trying to avoid missing intervention-requiring trauma or all radiographic TBI.
PECARN in Infants Under 3 Months
- Clinically important TBI risk: Among infants under 3 months who met PECARN low-risk criteria, clinically important TBI was rare at 0.2%, supporting the rule as a safety tool for the injuries that change immediate management.
- CT injury miss rate: Low-risk infants still had TBI on CT in 5.1%, a reminder that PECARN is stronger for ruling out clinically important TBI than for excluding every radiographic injury.
- Skull fracture signal: Even in the PECARN low-risk group, skull fracture appeared on CT in 4.6%, reinforcing that low risk does not mean no injury in very young infants.
- Negative subgroup finding: Infants who were PECARN low risk and had no additional concerning findings outside the rule had no clinically important TBIs. We get into why that distinction matters in the episode.
- Clinical goal mismatch: The practical question is whether your target is neurosurgical or airway-threatening injury versus all CT-detected TBI, because the rule performs much better for the first goal than the second.
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Faculty
- Mizuho Morrison, DO
Dr. Mizuho Morrison is a board-certified Emergency Medicine physician practicing in Southern California. She played a leadership role in FeminEM, helping develop and support its speaker coaching program, and occasionally contributes to Rebel EM. Additionally, Mizuho is an entrepreneur, co-founding 3MD| Three Mommy Doctors, a medical device company that redesigned first-aid kits for children. She lives in Orange County, CA, with her two children.
- Matthew DeLaney, MD, FACEP, FAAEM
Dr. Matthew DeLaney is an emergency medicine physician and educator based in Birmingham, Alabama. A native of Mobile, he earned his medical degree from the University of South Alabama and completed his emergency medicine residency at Maine Medical Center.Dr. DeLaney has experience in both community and academic emergency medicine and is known for his commitment to teaching and medical education. He lives in Birmingham with his wife, Erin, who is also a physician, and their two daughters.
