PECARN C-Spine Imaging Rule

Aka: PECARN C-Spine Imaging Rule, Cervical Spine Imaging Rule in Children, Pediatric Cervical Spine Imaging Decision Too;

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II. Indications

  1. Blunt Cervical Spine Injury in children age <18 years

III. Precautions

  1. This decision rule is proposed, but has not been fully validated as of 2024

IV. Criteria

  1. High Risk Features (12% Incidence of C-Spine Injury)
    1. Glasgow Coma Scale (GCS) 3 to 8
    2. Unresponsive on AVPU Scale
    3. ABC Evaluation with abnormalities (airway, breathing, circulation)
    4. Focal neurologic deficits
  2. Moderate Risk Features (2.8% Incidence of C-Spine Injury)
    1. Glasgow Coma Scale (GCS) 9 to 14
    2. Verbal or Pain on AVPU Scale
    3. Altered Mental Status
    4. Neck Pain or tenderness
    5. Head or torso injury warranting inpatient observation or surgical intervention
      1. Examples: Skull Fracture, Pneumothorax, Pelvic Fracture, solid organ injury
  3. Low Risk Features (0.2%)
    1. No High or Moderate risk factors

V. Interpretation

  1. Any high risk features
    1. Consider CT Cervical Spine
  2. Any moderate risk features
    1. Consider Cervical Spine XRay
  3. Only low risk features
    1. Consider no Cervical Spine imaging and spine clearance by clinical evaluation

VI. References

  1. Leonard (2024) Lancet Child Adolesc Health 8(7):482-90 +PMID: 38843852 [PubMed]

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