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Understanding Cervical Spine Injury Imaging Decision-Making in Pediatric Trauma Patients.
Fahd A Ahmad1, Sara Malone2, Ana Baumann3
1Washington University School of Medicine in St. Louis & St. Louis Children's Hospital.
Pediatrics Open Science
|April 9, 2026
Summary
Implementing the Pediatric Emergency Care Applied Research Network (PECARN) cervical spine injury (CSI) clinical prediction rule (CPR) faces barriers like workflow and EHR integration. Context-specific strategies and clinician engagement are key for successful adoption in pediatric trauma care.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Decision Support
- Health Services Research
Background:
- The Pediatric Emergency Care Applied Research Network (PECARN) cervical spine injury (CSI) clinical prediction rule (CPR) aims to reduce unnecessary imaging in pediatric trauma.
- Successful implementation of clinical prediction rules is crucial for evidence-based practice in emergency departments.
Purpose of the Study:
- To identify barriers and facilitators to the future implementation of the PECARN CSI CPR in diverse US emergency department settings.
- To inform the development of context-sensitive implementation strategies for the PECARN CSI CPR.
Main Methods:
- Conducted 40 semi-structured interviews with 48 clinicians (physicians, surgeons, nurses, APPs) across 21 US healthcare facilities.
- Utilized the Tailored Implementation for Chronic Diseases (TICD) framework to guide the exploration of implementation determinants.
- Performed deductive thematic analysis of interview transcripts, with independent coding by three researchers.
Main Results:
- Key barriers include limited guideline accessibility, workflow disruptions, and poor electronic health record (EHR) integration.
- Clinician concerns about guideline applicability and adherence were significant.
- Facilitators include institutional support, stakeholder engagement, and targeted education; context-sensitive strategies like EHR decision tools or pocket cards are suggested.
Conclusions:
- Successful implementation of the PECARN CSI CPR necessitates addressing workflow, clinician adherence, and technology integration challenges.
- Context-sensitive strategies tailored to specific healthcare settings are essential for adoption.
- Future research should evaluate the impact of implementation strategies on clinical practice and patient outcomes.
