Prehospital Factors Associated with Cervical Spine Injury in Pediatric Blunt Trauma Patients.

BACKGROUND 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 cervical spine injury 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-observed historical, mechanistic, and physical exam factors with cervical spine injury 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. METHODS We conducted a 4-center, prospective observational study of children 0 to 17 years-old who were transported by EMS after blunt trauma and underwent spinal motion restriction (SMR) or trauma team activation in the ED. In the ED, EMS providers recorded their observations for a priori-determined CSI risk factors. CSIs were classified by reviewing imaging, consultations, and/or telephone follow-up. We calculated bivariable relative risks and test characteristics for the PECARN model based solely on EMS provider observations. RESULTS Of 1,372 enrolled children, 25 (1.8%) had CSIs. Of the a priori-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-risk 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, 96.0% (95% confidence interval: 88.3%-103.7%); negative predictive value, 99.8% (99.4%-100.2%); specificity, 38.5% (35.9%-41.1%); and positive predictive value, 2.8% (1.7%-3.9%). CONCLUSION 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 preshospital setting.