INTRODUCTION: Clinical decision rules aid clinicians with the management of head 
injured patients. This study aimed to identify clinical decision rules for 
children with minor head injury and compare their diagnostic accuracy for 
detection of intracranial injury (ICI) and injury requiring neurosurgical 
intervention (NSI).
METHODS: Relevant studies were identified by an electronic search of key 
databases. Papers in English were included with a cohort of at least 20 children 
suffering minor head injury (GCS 13-15). Studies of a decision rule derived to 
identify patients at risk of ICI or NSI had to include a proportion of the 
cohort undergoing imaging. Study quality was assessed using the QUADAS 
checklist.
RESULTS: 16 publications, representing 14 cohorts, with 79 740 patients were 
included. Only four rules were tested in more than one cohort. Of the validated 
rules the paediatric emergency care applied research network (PECARN) rule was 
most consistent (sensitivity 98%; specificity 58%). For neurosurgical injury all 
had high sensitivity (98-100%) but the children's head injury algorithm for the 
prediction of important clinical events (CHALICE) rule had the highest 
specificity (86%) in its derivation cohort.
CONCLUSION: Of the current decision rules for minor head injury the PECARN rule 
appears the best for children and infants, with the largest cohort, highest 
sensitivity and acceptable specificity for clinically significant ICI. 
Application of this rule in the UK would probably result in an unacceptably high 
rate of CT scans per injury, and continued use of the CHALICE-based NICE 
guidelines represents an appropriate alternative.