{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T20:16:02Z","timestamp":1791317762105,"version":"4.3.1"},"reference-count":23,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Pediatric cervical spine injury (CSI) is a rare occurrence; however, CSI can result in significant disability and death. It is essential to determine the optimal CSI clinical prediction rule to risk stratify children with potential CSI after blunt trauma who require cervical spine imaging.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare the test characteristics and projected imaging rates between 3 prospectively derived CSI clinical prediction rules: the Pediatric Emergency Care Applied Research Network CSI prediction rule (PECARN CSI rule), the National Emergency X-Radiography Utilization Study (NEXUS), and the Canadian Cervical Spine (c-spine) rule (CCR).<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This comparative effectiveness study was a planned secondary analysis of a prospective observational study enrolling from December 2018 to October 2021 in 18 PECARN emergency departments. Eligible participants were children up through age 17 years presenting after blunt trauma. Data were analyzed between March 2024 and January 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Enrollment in the primary study to develop and validate the PECARN CSI prediction rule.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome Measures<\/jats:title>\n Test characteristics with 95% CIs (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) and area under the curve (AUC) for the receiver operator curves (ROC) for the detection of CSI using each of the 3 rules. We also estimated the projected c-spine imaging rate (radiography or computed tomography [CT]) based on criteria for each of the 3 rules.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n There were 22\u202f430 eligible children enrolled (median [IQR] age 8 [2.0-13.0] years; 13\u202f068 male [58.3%]) and 433 (1.9%) had CSI. C-spine imaging was performed 12\u202f768 children (56.9%): 8912 (39.7%) had radiography and 3856 (17.2%) were imaged with CT. The sensitivity of the 3 rules was: PECARN CSI rule, 93.3% (95% CI, 90.9%-95.7%); NEXUS, 85.7% (95% CI, 82.4%-89.0%); and CCR, 90.8% (95% CI, 88.0%-93.5%). The NPV of the 3 rules was: PECARN, 99.8% (95% CI, 99.7%-99.9%); NEXUS, 99.6% (95% CI, 99.5%-99.7%); and CCR, 99.7% (95% CI, 99.6%-99.8%). Strictly applying each rule resulted in projected CT imaging of 1549 children (6.9%) for PECARN, 2419 (10.8%) for NEXUS, and 2968 (13.2%) for CCR.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this comparative effectiveness study of CSI prediction rules in children, the PECARN CSI rule had the highest sensitivity and NPV for identifying children at risk for CSI after blunt trauma, with the lowest projected CT imaging rate.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.49403","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T16:30:34Z","timestamp":1766161834000},"page":"e2549403","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of Cervical Spine Injury Clinical Prediction Rules for Children After Blunt Trauma"],"prefix":"10.1001","volume":"8","author":[{"given":"Lois K.","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Department of Pediatrics, Harvard Medical School, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahd A.","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Emergency Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorin R.","family":"Browne","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Harding","sequence":"additional","affiliation":[{"name":"Utah Data Coordinating Center, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Cook","sequence":"additional","affiliation":[{"name":"Utah Data Coordinating Center, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Adelgais","sequence":"additional","affiliation":[{"name":"Section of Pediatric Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca K.","family":"Burger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Emergency Medicine, Emory University School of Medicine, Children\u2019s Healthcare of Atlanta, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Rogers","sequence":"additional","affiliation":[{"name":"Departments of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah","family":"Tzimenatos","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of California, Davis School 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Medicine, Department of Pediatrics, Children\u2019s Health Dallas, University of Texas Southwestern Medical Center, Dallas"},{"name":"Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie C.","family":"Leonard","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children\u2019s Hospital, Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"issue":"3","key":"zoi251327r1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011686.pub3","article-title":"Triage tools for detecting cervical spine injury in paediatric trauma patients.","volume":"3","author":"Tavender","year":"2024","journal-title":"Cochrane Database Syst 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