Written by Joshua Belfer
The PECARN cervical spine injury prediction rule performed well when applied by EMS clinicians, with high sensitivity and negative predictive value, suggesting it may help reduce unnecessary spinal motion restriction in children after blunt trauma.
PECARN to go: Can EMS call the (c‑spine) shots?
We rely on clinical prediction rules in the ED all the time, but what about in the field? The newly derived PECARN cervical spine injury (CSI) rule was developed to identify children at risk for cervical spine injury after blunt trauma. To reduce unnecessary prehospital spinal motion restriction (SMR), we need to know: can EMS clinicians apply it just as well?
This multicenter, prospective subanalysis of the PECARN CSI study assessed how the rule performs when applied by EMS. Of 7,721 children with blunt trauma and EMS-completed data forms, sensitivity was 88.5% (95%CI 82.9-94.2%) and negative predictive value 99.7% (95%CI 99.6-99.9%) for identifying CSI. Specificity was 63.1%, and positive predictive value was low at 3.7%, which is expected given the rarity of CSI. Application of the rule would have reduced SMR use from 41.5% to 37.7% and longboard use from 17.0% to 9.8%.
Limitations include potential selection bias (only 57% of EMS-eligible patients had completed forms). Additionally, 14 CSI cases (11.5%) were missed when used by EMS, though many had documented risk factors later noted in the ED.
How will this change my practice?
When a child arrives in a C-collar placed in the field, we ask the usual questions: Can we clear it clinically? Do they need imaging? X-ray or CT? Cervical spine management in pediatrics is notoriously tricky, but the recent landmark PECARN study offers some much-needed clarity.
Encouragingly, the PECARN C-spine rule performs well by EMS––as long as key risk factors are appropriately recognized. When used properly, this means fewer kids unnecessarily strapped to longboards or left in uncomfortable collars.
While there’s room for improvement, this is a promising step toward better prehospital care for pediatric trauma patients.
Source
Performance of the PECARN cervical spine injury prediction rule based on EMS clinician observations. J Trauma Acute Care Surg. 2025 Aug 21. doi: 10.1097/TA.0000000000004772. Epub ahead of print. PMID: 40836370.
