The PECARN paediatric C-Spine rules are here
Will they help us, or create confusion and lead to more imaging being performed? Read the summary points below and see the rule, then watch the video discussion where Paediatric Emergency Physician Dr Claire Wilkin-Marshall Joins me to discuss this important study. The results may surprise you.
This discussion and my take and video are included in your EM Mastery Subscription, however I have made this page open access for the next 72 hours, so everyone can be included in what this study might mean. Members can watch this video again in the October content.
Key Points from this Study
The negative predictive value was found to be 99.9% 99·9% (99·8–100·0)
That's impressive, but right now, this won't neccassarily change my practice.
Go to the October Papercut Review of this study to see why.
Join us at EMCORE Sydney, where we will be discussion the approach to the paediatric trauma patient.
JOIN EM MASTERYTHEÂ STUDY
Leonard J C et al. PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. Lancet Child Adolesc Health 2024; 8: 482–90. doi:10.1016/S2352-4642(24)00104-4
THE RULE: A SUMMARY
Some Key Points
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In this study they derived and validated a clinical prediction rule for cervical injury in children.
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 It was a prospective observational study at 18 Level-1 paediatric trauma centres
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Sensitivity 94.3%, Specificity 60.4% and NPV 99.9%Â
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 Mechanism was not included in this study.
- The plain C spine comes back into focus. I don't know about you, but I haven't read a paediatric C-spine in years. Also I don't think they're very good for the very young
- The rule is all-comers, but it seems to not be well suited to the very young children.
- Parts of the rule, such as seeking 'focal neurology' may be very difficult to determine, especially in the very young.
- The high risk criteria, are those children I would do a CT in anyway.