II. Indications
- Blunt Cervical Spine Injury in children age <18 years
III. Precautions
- This decision rule is proposed, but has not been fully validated as of 2024
IV. Criteria
- High Risk Features (12% Incidence of C-Spine Injury)
- Glasgow Coma Scale (GCS) 3 to 8
- Unresponsive on AVPU Scale
- ABC Evaluation with abnormalities (airway, breathing, circulation)
- Focal neurologic deficits
- Moderate Risk Features (2.8% Incidence of C-Spine Injury)
- Glasgow Coma Scale (GCS) 9 to 14
- Verbal or Pain on AVPU Scale
- Altered Mental Status
- Neck Pain or tenderness
- Head or torso injury warranting inpatient observation or surgical intervention
- Examples: Skull Fracture, Pneumothorax, Pelvic Fracture, solid organ injury
- Low Risk Features (0.2%)
- No High or Moderate risk factors
V. Interpretation
- Any high risk features
- Consider CT Cervical Spine
- Any moderate risk features
- Consider Cervical Spine XRay
- Only low risk features
- Consider no Cervical Spine imaging and spine clearance by clinical evaluation
VI. Efficacy
- Based on study of 22,000 children in 18 Emergency Departments within the PECARN network
- Inclusion criteria were broad, including infants, and suspected Nonaccidental Trauma
- Test Sensitivity 94.3%
- Negative Predictive Value: 99.9%
- Benefits
- Predicted to reduce CT C-Spine imaging by 50% in pediatric blunt Trauma
- Fills the gap for validated C-Spine rules in children
- Assumes clinician or radiologist experience in reading pediatric C-Spine XRays
VII. References
- Claudius, Woods, Leonard and Magana (2024) EM:Rap, 10/7/2024, accessed 10/31/2024
- Leonard (2024) Lancet Child Adolesc Health 8(7):482-90 +PMID: 38843852 [PubMed]