{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T06:07:34Z","timestamp":1769753254095,"version":"3.49.0"},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,12,15]],"date-time":"2020-12-15T00:00:00Z","timestamp":1607990400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R21HD076108\u201002"],"award-info":[{"award-number":["R21HD076108\u201002"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The risk for cervical spine injury (CSI) must be assessed in children who sustain blunt trauma. The Pediatric Emergency Care Applied Research Network (PECARN) retrospectively derived CSI model identifies CSI risk in children based on emergency department (ED) provider observations. The objective of this pilot study was to determine the univariate association of emergency medical services (EMS) provider\u2010observed historical, mechanistic, and physical examination factors with CSI in injured children. Secondarily, we assessed the performance of the previously identified eight PECARN CSI risk factors (PECARN model) based exclusively on EMS provider observation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a four\u2010center, prospective observational study of children 0 to 17\u00a0years old who were transported by EMS after blunt trauma and underwent spinal motion restriction or trauma team activation in the ED. In the ED, EMS providers recorded their observations for <jats:italic>a priori<\/jats:italic> determined CSI risk factors. CSIs were classified by reviewing imaging, consultations, and\/or telephone follow\u2010up. We calculated bivariable relative risks and test characteristics for the PECARN model based solely on EMS provider observations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 1,372 enrolled children, 25 (1.8%) had CSIs. Of the <jats:italic>a priori<\/jats:italic> determined CSI risk factors, seven factors had bivariable associations with CSIs: axial load, altered mental status, signs of basilar skull fracture, substantial torso injury, substantial thoracic injury, respiratory distress, and decreased oxygen saturation. The PECARN model (high\u2010risk motor vehicle collision, diving mechanism, predisposing condition, neck pain, decreased neck mobility, altered mental status, neurologic deficits, and\/or substantial torso injury) exhibited the following test characteristics when based on EMS provider observations: sensitivity\u00a0= 96.0% (95% confidence interval [CI]\u00a0= 88.3% to 100.0%); negative predictive value\u00a0= 99.8% (95% CI\u00a0= 99.4% to 100.0%); specificity\u00a0= 38.5% (95% CI\u00a0= 35.9% to 41.1%); and positive predictive value\u00a0= 2.8% (95% CI\u00a0= 1.7% to 3.9%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>EMS providers can identify risk factors associated with CSI in injured children who experience blunt trauma. These risk factors may be considered for inclusion in a pediatric CSI decision rule specific to the prehospital setting.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14176","type":"journal-article","created":{"date-parts":[[2020,11,21]],"date-time":"2020-11-21T08:38:12Z","timestamp":1605947892000},"page":"553-561","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Prehospital Factors Associated With Cervical Spine Injury in Pediatric Blunt Trauma Patients"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8160-3035","authenticated-orcid":false,"given":"Lorin R.","family":"Browne","sequence":"first","affiliation":[{"name":"From the Department of Pediatrics and Emergency Medicine Medical College of Wisconsin Milwaukee WI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5919-6835","authenticated-orcid":false,"given":"Fahd A.","family":"Ahmad","sequence":"additional","affiliation":[{"name":"the Department of Pediatrics Washington University School of Medicine in St. Louis St. Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamilton","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Cincinnati Children\u2019s Hospital Medical Center and University of Cincinnati College of Medicine Cincinnati OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Wallendorf","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Washington University School of Medicine in St. Louis St. Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan","family":"Kuppermann","sequence":"additional","affiliation":[{"name":"the Department of Emergency Medicine and Pediatrics University of California Davis School of Medicine Sacramento CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0043-3757","authenticated-orcid":false,"given":"E. Brooke","family":"Lerner","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University at Buffalo Buffalo NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie C.","family":"Leonard","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Nationwide Children\u2019s Hospital and The Ohio State University College of Medicine Columbus OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,12,15]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.3109\/10903127.2014.995850"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-3505"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.108.2.e20"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2016.1254696"},{"key":"e_1_2_7_6_1","volume-title":"Emergency: Care and Transportation of the Sick and Injured","author":"Pollak A","year":"2011"},{"key":"e_1_2_7_7_1","volume-title":"Prehospital Trauma Life Support","author":"American College of Surgeons Committee on Trauma","year":"2010"},{"key":"e_1_2_7_8_1","first-page":"CD002803","article-title":"Spinal immobilisation for trauma patients","volume":"2001","author":"Kwan I","year":"2001","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.3109\/10903127.2012.689925"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-1383(96)00115-5"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181b5f32e"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181c9ee58"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/10903129908958967"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2018.1481476"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200007133430203"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.091430"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2009.03.008"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1067\/mem.2001.114409"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2005.02.004"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2010.08.038"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13312"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13144"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-3221"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2019.1585502"},{"key":"e_1_2_7_25_1","first-page":"1","article-title":"Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011","volume":"61","author":"Sasser SM","year":"2012","journal-title":"MMWR Recomm Rep"},{"key":"e_1_2_7_26_1","unstructured":"Emergency Triage Treat and Transport (ET3) Model.Centers for Medicare & Medicaid Services.2020. 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