Palchak (UC Davis) Rule for Paediatric Head Trauma CT Prediction
Clinical decision rule for CT head in children with blunt head trauma. Developed at UC Davis to identify children at low risk for traumatic brain injury without CT scanning.
Score interpretation
No Palchak criteria present -- low risk of traumatic brain injury; CT not indicated
→ No CT head required; observe in ED for 4-6 hours; written head injury advice on discharge: return immediately if worsening headache, repeated vomiting, seizure, drowsiness/difficulty waking, confusion, weakness, or unsteadiness; adult supervision for 24 hours; avoid alcohol and sedating medications; no return to sport until symptom-free and cleared by clinician; prefer PECARN over Palchak when both applicable.
One or more Palchak criteria present -- CT head indicated
→ CT head without contrast urgently; neurosurgical referral if: intracranial haemorrhage, depressed skull fracture, mass effect, midline shift > 5 mm; admit all positive CT results; GCS and neuro obs every 30 minutes; senior paediatric review; if GCS < 9 or rapidly deteriorating: intubation and PICU referral; repeat CT in 24-36 hours if initial CT positive and no operative intervention; consider NAI if mechanism inconsistent or multiple injuries.
Interpretation bands for the Palchak Rule. Apply clinical judgement and local guidance.
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.
- NICE NG232. Head injury: assessment and early management. NICE. 2023.
Related
Curated clinical cross-links plus same-class fallbacks.
- Ibuprofen (Paediatric) · NSAID / Analgesic / Antipyretic
- Paracetamol (Paediatric) · Analgesic / Antipyretic — First-Line Pain and Fever in Children
- Morphine (Paediatric) · Opioid Analgesic — Moderate to Severe Pain in Children
- Gentamicin (Paediatric) · Aminoglycoside — Neonatal Sepsis / Gram-Negative Infections in Children
- Vancomycin (Paediatric) · Glycopeptide Antibiotic — MRSA / Severe Gram-Positive Infections in Children
- Iron Supplementation (Paediatric) · Iron Supplement — Iron Deficiency Anaemia in Children
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.