Injury prediction rule could decrease radiographic imaging exposure in children, study shows

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 computed tomography (CT) scans, both of which expose children to radiation, which can cause other health issues over time.

In a study published in The Lancet Child & Adolescent Health, researchers from the Pediatric Emergency Care Applied Research Network (PECARN)—led by Julie Leonard, MD, MPH at Nationwide Children’s Hospital—have created a highly accurate cervical spine injury prediction rule. When applied, the rule decreases the use of CT by more than 50% without missing clinically significant injuries or increasing normal X-ray use.

“Emergency medical professionals prioritize thoroughness to ensure no serious injuries are overlooked, a crucial aspect in caring for every trauma patient,” said Dr. Leonard, an emergency medicine physician at Nationwide Children’s. “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.”

The study 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, 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.

“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,” said Dr. Leonard, who is the principal investigator of the Great Lakes Atlantic Children’s Emergency Research node (GLACiER) 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.”