When is it safe to forego a CT in kids with head trauma?

From the Journal of Family Practice:

The PECARN decision rules should simplify head trauma assessment in children. Physicians should first check for altered mental status and signs of skull fracture and immediately send the patient for imaging if either is present. Otherwise, physicians should continue the assessment—looking for the other clinical predictors and ordering a brain CT if 1 or more are found. However, risk of ciTBI is only 1% when only 1 prediction criterion is present. These cases require careful consideration of the potential benefit and risk.

Some emergency physicians may resist using a checklist approach, even one as useful as the PECARN decision guide, and continue to rely solely on their clinical judgment. And some parents are likely to insist on a CT scan for reassurance that there is no TBI, despite the absence of any clinical predictors.