Performance of the PECARN cervical spine injury prediction rule based on EMS clinician observations.

Background: Pediatric cervical spine injury (CSI) is associated with substantial morbidity and mortality. The Pediatric Emergency Care Applied Research Network (PECARN) developed a CSI prediction rule for evaluating children after blunt trauma in the emergency department (ED). The objective of this study was to evaluate the performance of the PECARN CSI prediction rule using emergency medical services (EMS) clinician observations.

Methods: We conducted a multicenter prospective observational study of children younger than 18 years with blunt trauma who were transported to one of 18 participating PECARN EDs by EMS. A convenience sample of EMS clinicians completed case report forms regarding CSI risk factors based on their clinical observations. We then evaluated rule performance with 95% confidence intervals (CI) by applying the PECARN prediction rule using the EMS clinical observations with the primary outcome of CSI. We also calculated rates of spinal motion restriction (SMR) had the algorithm been followed for the study population.

Results: Emergency medical services clinicians completed case report forms for 7,721 (57.4%) patients. Using these EMS cohort data, the PECARN CSI prediction rule had a sensitivity of 88.5% (95% CI, 82.9-94.2%), specificity of 63.1% (95% CI, 62.0-64.2%), positive predictive value of 3.7% (95% CI, 3.0-4.4%), and negative predictive value of 99.7% (95% CI, 99.6-99.9%). The proportion of children placed in SMR would have decreased from 41.5% to 37.7%, and longboard use would have decreased from 17.0% to 9.8% had the rule been applied to this cohort.

Conclusion: The PECARN CSI prediction rule based on EMS clinician observations had good accuracy for CSI in children experiencing blunt trauma. Application of the prediction rule to our EMS patient population would have reduced both SMR and longboard use.

Level Of Evidence: Prospective Observational; Level III.