In this prospective study, the authors compared presenting clinical features and emergent head computed tomography (CT) findings for 300 pediatric patients with closed-head trauma over a 9-month study period. Prior to imaging, an evaluation was completed regarding 27 specific historical and physical findings, and the final disposition was noted for all patients. Overall, 53 (18%) patients were found to have CT abnormalities including depressed skull fractures, contusions, hematomas, and other acute findings. In children older than age 2, a suspected history of abuse, LOC >5 minutes, focal motor deficits, anisocoria, Glasgow Coma Score (GCS) <13, physical signs of a depressed or basilar skull fracture, and penetrating trauma all had a positive predictive value over 50% for an abnormal CT. The absence of a headache or amnesia indicated a less than 10% chance of having an abnormal CT for this group. For children less than age 2, suspected abuse, focal motor deficits, anisocoria, and signs of a depressed skull fracture had positive predictive values over 50%. Children with abnormal CTs were subsequently referred for neurosurgical intervention (30%), intensive care monitoring (51%), or were discharged (19%). Most patients with normal CTs (89%) were triaged to a routine department or discharged home. From their findings, the authors conclude that high-yield criteria for significant pathology in closed-head injuries include suspected abuse, focal motor deficits, and anisocoria; other specific findings, however, are also important depending on the patient's age. Judicious use of emergent head CTs in this population reduces unforeseen morbidity and costs.