Prediction Rule Cuts CT Use in Pediatric Emergency Use Case

Researchers in the Pediatric Emergency Care Applied Research Network (PECARN) have created a highly accurate cervical spine injury prediction rule. When applied, the researchers add, the rule decreases the use of computed tomography (CT) by more than 50% without missing clinically significant injuries or increasing normal X-ray use.  

While cervical spine injuries (CSI) are uncommon in children, they can be potentially devastating, resulting in quadriplegia – paralysis below the neck affecting both arms and both legs. Detecting CSIs in a clinical setting often requires imaging such as X-rays and CT scans, both of which expose children to radiation, which can cause other health issues over time.

The study, published in The Lancet Child & Adolescent Health, required the collaboration of 18 children’s hospitals to enroll more than 22,000 study participants over a period of three years. 
The resulting PECARN CSI prediction rule is easy for physicians to use, the researchers say, relying solely on a child’s symptoms and physical examination upon arrival in the emergency department. The prediction consists of nine clinical findings, four of which designate a child as “high-risk” for CSI and appropriate for initial screening with CT.

“Emergency medical professionals prioritize thoroughness to ensure no serious injuries are overlooked, a crucial aspect in caring for every trauma patient,” said Julie Leonard, M.D., M.P.H., in a statement. Leonard, who led the research team, is an emergency medicine physician at Nationwide Children’s Hospital in Columbus, Ohio. “However, we also understand the age-related radiation sensitivity and malignancy risk caused by use of CT, and we’re very encouraged that this new prediction rule could reduce some of that unnecessary exposure.”

“More research needs to be completed to determine how best to implement this rule into community emergency department settings, where most children are evaluated after trauma,” added Leonard, who is the principal investigator of the Great Lakes Atlantic Children’s Emergency Research (GLACiER) node of the PECARN. “We are hoping that this rule can empower families to collaborate even more closely with their children’s care teams for better clinical outcomes.”

GLACiER is one of seven nodes nationwide funded for research in pediatric emergency care as part of PECARN. The node includes Nationwide Children’s Hospital (Columbus, OH), University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh (Pittsburgh, PA), and Nemours Children’s Hospital (Wilmington, DE). PECARN conducts high-quality, multicenter research into the prevention and management of acute illnesses and injuries in children. Its research spans across the continuum of emergency care from prehospital to hospital settings. 

PECARN is funded by the federal Emergency Medical Services for Children program, part of the Health Resources and Services Administration.