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Comparison of Cervical Spine Injury Prediction Rule Across Ages
Daniel J Corwin1, Pradip P Chaudhari2, Leah Tzimenatos3
1Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
The Pediatric Emergency Care Applied Research Network (PECARN) cervical spine injury (CSI) rule performs similarly across all pediatric age groups. Age-specific rules also showed comparable performance, supporting the use of the PECARN CSI rule for all children.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Care
- Clinical Prediction Rules
Background:
- Cervical spine injuries (CSIs) are a significant concern in pediatric trauma.
- Existing prediction rules require validation across diverse pediatric age demographics.
- Age-specific variations in CSI risk factors and presentation necessitate tailored diagnostic approaches.
Purpose of the Study:
- To evaluate the performance of the Pediatric Emergency Care Applied Research Network (PECARN) cervical spine injury (CSI) prediction rule in different pediatric age groups.
- To derive and assess the efficacy of age-specific CSI prediction rules for children.
- To determine if the PECARN CSI rule is applicable across the entire pediatric age spectrum.
Main Methods:
- A secondary analysis of the PECARN CSI study data was performed on over 22,000 children (<18 years) with blunt trauma.
- Participants were stratified into four age groups: <2, 2-7, 8-15, and 16 to <18 years.
- Age-specific rules were developed using classification and regression tree (CART) analysis, focusing on high-risk predictors and identifying additional age-specific factors. Rule performance was measured by sensitivity, specificity, and predictive values.
Main Results:
- The Pediatric Emergency Care Applied Research Network (PECARN) cervical spine injury (CSI) prediction rule demonstrated consistent performance across all pediatric age groups, with sensitivity ranging from 91.7% to 94.4%.
- Derived age-specific rules exhibited similar sensitivity (88.4%-97.5%) and specificity (45.9%-75.9%) compared to the original PECARN CSI rule (specificity 44.6%-72.3%).
- All evaluated rules, including the PECARN CSI rule and age-specific variations, achieved high negative predictive values (NPVs) of 99.6% or greater across all age strata.
Conclusions:
- The performance of age-specific cervical spine injury (CSI) prediction rules is comparable to the established Pediatric Emergency Care Applied Research Network (PECARN) CSI prediction rule.
- These findings validate the utility of the PECARN CSI prediction rule for application across the full spectrum of pediatric patients.
- Clinicians can confidently utilize the PECARN CSI prediction rule for the initial assessment of cervical spine injury risk in children of all ages.
Objective:
To evaluate the performance of the Pediatric Emergency Care Applied Research Network (PECARN) cervical spine injury (CSI) prediction rule among different pediatric age groups and derive and assess age-specific CSI prediction rules.
Methods:
We conducted a planned secondary analysis of the PECARN CSI study of children younger than 18 years with known or suspected blunt trauma evaluated at 1 of 18 children's hospitals' emergency departments. Participants were divided into 4 clinically relevant age groups (<2, 2-7, 8-15, and 16 to <18 years). Age-specific rules were derived from the 4 high-risk predictors of the PECARN CSI Prediction Rule and using a classification and regression tree (CART) analysis to identify additional non-negligible age-specific risk factors. Rule performance was assessed using sensitivity, specificity, and positive and negative predictive values (NPVs) for each age group.
Results:
There were 22 430 participants included in analysis. Three to 8 risk factors were identified as non-negligible risk in CART analysis for each age-specific rule. The sensitivity of the PECARN CSI Prediction Rule (range 91.7%-94.4% across age groups) was similar to age-specific rules (range 88.4%-97.5%). The specificity of the PECARN CSI Prediction Rule (range 44.6%-72.3% for age groups) was also similar to age-specific rules (range 45.9%-75.9%). NPVs (all ≥99.6%) were similar across age groups for all rules.
Conclusions:
Rule performance for the age-specific CSI prediction rules and the PECARN CSI Prediction Rule were similar. These findings support clinicians' use of the PECARN CSI Prediction Rule across the pediatric age spectrum.
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