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PECARN C-Spine Imaging Rule

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

  • See Also
  1. Cervical Spine Imaging in Acute Traumatic Injury
  2. Pediatric Cervical Spine Injury
  3. Cervical Spine Injury
  4. NEXUS Criteria
  5. Canadian Cervical Spine Rule
  • Indications
  1. Blunt Cervical Spine Injury in children age <18 years
  • Precautions
  1. This decision rule is proposed, but has not been fully validated as of 2024
  • 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
  • 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
  • Efficacy
  1. Based on study of 22,000 children in 18 Emergency Departments within the PECARN network
    1. Inclusion criteria were broad, including infants, and suspected Nonaccidental Trauma
  2. Test Sensitivity 94.3%
  3. Negative Predictive Value: 99.9%
  4. Benefits
    1. Predicted to reduce CT C-Spine imaging by 50% in pediatric blunt Trauma
    2. Fills the gap for validated C-Spine rules in children
    3. Assumes clinician or radiologist experience in reading pediatric C-Spine XRays
  • References
  1. Claudius, Woods, Leonard and Magana (2024) EM:Rap, 10/7/2024, accessed 10/31/2024
  2. Leonard (2024) Lancet Child Adolesc Health 8(7):482-90 +PMID: 38843852 [PubMed]