Palchak (UC Davis) Rule for Pediatric Head Trauma

Why Use

Helps identify low-risk children who may safely avoid head CT, reducing unnecessary radiation exposure. Demonstrated greater sensitivity in identifying children with TBI compared to clinical judgment alone.

When to Use

Use in emergency settings for pediatric patients (<18 years) presenting with blunt head trauma. Intended for risk stratification of clinically significant traumatic brain injury (TBI) to guide decisions on the necessity of head CT.

Formula

Pearls / Pitfalls

Does not apply to patients with obvious indications for emergent imaging (e.g., profound neurological deficits, penetrating injuries). The derivation study excluded children with “trivial” head trauma, defined as falls from ground level or trauma from walking or running into stationary objects when the only abnormal finding was a scalp laceration or abrasion. The study included various mechanisms of injury, including motor vehicle accidents, automobile-versus-pedestrian incidents, assault, bicycle crashes, child abuse, and automobile-versus-bicycle collisions. The negative predictive value for patients without any high-risk variables was nearly 100%.

Management

Low-risk cases: Consider observation instead of immediate imaging. If imaging is deferred, ensure caregiver education and appropriate follow-up. Elevated-risk cases: If one or more high-risk criteria are met, head CT should be strongly considered.

Advice

This tool should be used in conjunction with clinical judgment. A thorough evaluation is essential, and factors such as non-accidental trauma or high-impact injury mechanisms require individual consideration.