A just released study published in the Lancet gives us guidance on which pediatric blunt trauma patients need cervical spine imaging.  Age range was 0-17 years.

“Out of 22,430 children included in the study, 433 (1.9%) were found to have Cervical spine injury (CSI). The study identified 4 high risk factors for CSI to be used to triage children to CT (12% risk for a cervical spine injury):

1. Glasgow Coma Scale scores of 3-8
2. Unresponsiveness to on the AVPU scale
3. Abnormal airway/breathing/circulation
4. Focal neurologic deficits

In children without high-risk findings, 5 additional findings identified children with intermediate, non-negligible risk of CSI (3.6% risk of a cervical spine injury):

1. Altered mental status
2. Substantial head
3. Substantial torso injury
4. Midline neck pain
5. Midline neck tenderness”

References

1.  The Lancet ARTICLES| VOLUME 8, ISSUE 7, P482-490, JULY 2024

PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study

Prof Julie C Leonard, MD Monica Harding, MS Prof Lawrence J Cook, PhD Prof Jeffrey R Leonard, MD

Prof Kathleen M Adelgais, MD Fahd A Ahmad, MD et al.

Published:June 03, 2024DOI:https://doi.org/10.1016/S2352-4642(24)00104-4

2. https://pecarn.org/pecarn_news/clinical-decision-rule-cervical-spine/