Pem pearl: PEcarn pediatric c-spine

​Cervical spine imaging in the setting of pediatric blunt trauma suffers from a paucity of clinical guidelines and prediction rules. Cervical Spine Injury (CSI) presents carries a high risk and CT imaging exposes children to ionizing radiation which increases lifetime risk of cancer.  Fortunately, our colleagues in the PECARN network have validated a prediction rule to help identify children at risk of CSI after blunt trauma, to help minimize risk of radiation exposure. Data regarding physical signs and symptoms of 22,430 children under 18 years old with concern for CSI were obtained. 1.9% were found to have CSI and 4 criteria were extrapolated to assess need for CT vs cervical X-ray or clearance. The implemented prediction rule yielded a 94.3% sensitivity and a 99.9% negative predictive value.
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​Take home
CSI in children remains uncommon but potentially devastating; however indiscriminate neck imaging after trauma unnecessarily exposes children to ionizing radiation. Hopefully this prediction rule will help to mitigate both risks. If they are in a bad way, scan them. If the exam is nuanced, start with an x-ray. If there is no risk, take off the collar.