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Background Evidence-based clinical prediction rules (CPRs) improve care delivery to children in the emergency department (ED); however, clinician-level factors may impact rule implementation. We aimed to investigate the association between clinician characteristics and their risk tolerances with CT scan ordering in children with blunt head trauma at very low risk for clinically important traumatic brain injuries (ciTBI).Methods As part of a prospective multicentre study of children with minor head trauma (Glasgow Coma Scale scores ≥14), we collected data from ED clinicians on clinician demographics, clinical experience, self-reported risk tolerance and perceptions/self-reported use of CPRs. Children enrolled were considered very low risk for ciTBI if they were negative for the Pediatric Emergency Care Applied Research Network (PECARN) TBI CPRs. Survey results were linked to the children they enrolled in the analytic database. We performed multivariable logistic regression to identify clinician-level factors associated with CT ordering in children at very low risk of ciTBI.Results Of 481 clinicians, 421 (88%, 95% CI 84% to 90%) completed the survey. Among the 8957 children at very low risk for ciTBI, 654 (7.3%, 95% CI 6.8% to 7.9%) underwent CT scanning. In multivariable modelling, clinician-reported characteristics associated with ordering CTs in very low risk children included years of experience (adjusted OR (aOR) 1.02, 95% CI 1.00 to 1.03), caring for <50% children in one’s practice (aOR 1.55, 95% CI 1.13 to 2.12) and avoidance of uncertain outcomes (aOR 1.31, 95% CI 1.02 to 1.69).Conclusions Despite awareness of the PECARN TBI CPRs, some clinicians ordered CTs for children at very low risk for ciTBI. More years of practice, lower clinician risk tolerance and lower proportion of children in one’s clinical practice were associated with higher CT use. Increasing involvement of providers with greater paediatric expertise in imaging decisions and addressing clinician perceptions and decision-making biases may further safely lower CT use in children with minor head trauma.