PECARN: C-SPINE study - developing a risk assessment tool & identifying modifiable health care disparities in children with cervical spine injuries

Cervical spine injuries (CSI) are serious but rare events in children. In prehospital settings, spinal precautions, such as rigid cervical collars, long backboards, and straps, may be beneficial for children with CSI but are poorly studied. In contrast, spinal precautions for pediatric trauma patients without CSI are common and may be associated with harm.

Therefore, there is an urgent need to develop a pediatric CSI risk assessment tool. The tool, when used in prehospital settings and emergency departments, would reduce the number of potentially avoidable prehospital spinal precautions and emergency department cervical spine imaging procedures, while identifying children who are truly at risk for CSI. 

The Pediatric Emergency Care Applied Research Network (PECARN), funded by the Health Resources and Services Administration and Emergency Medical Services for Children, is engaged in a study to address that need. 

The study, “Development and Testing of a Pediatric Cervical Spine Injury Risk Assessment Tool (C-SPINE),” led by Dr. Julie Leonard at Nationwide Children’s Hospital, aims to develop and test a pediatric CSI risk assessment tool that can be used by prehospital and emergency medicine providers to determine which children warrant spinal precautions and cervical spine imaging after blunt trauma. This could lead to significant changes in recommendations for the treatment and transport of injured children worldwide. 

To date, the PECARN C-SPINE study has enrolled 22,452 children with blunt trauma. Among enrolled children, 434 of these children have cervical spine injuries; of those, nearly half arrived via emergency medical services (EMS) transport to the participating children’s hospitals. 

As a supplement to the C-SPINE study, Dr. Jordee Wells, also at Nationwide Children’s Hospital, successfully competed for a R01 Diversity Supplement through NICHD to evaluate the association of pediatric CSI treatment and outcomes with health inequities. Addressing social factors to reduce health inequities is a global health care priority, but the nature of their association with pediatric treatment and outcomes of CSI remains unstudied. The goal of the sub-study is to identify modifiable health care disparities in children with pediatric CSI and aid in implementing targeted interventions that support improved health care delivery, post-injury care management and functional outcomes. 

To date, the C-SPINE Diversity Supplement sub-study has enrolled 379 children, and the study team is reviewing their medical records for social factors that may contribute to pediatric CSI risk. The study team has also completed 114 phone follow-up interviews to evaluate for any disparities in health care delivery, post-injury care management and functional outcomes.

The study team is currently analyzing data and anticipates having results later this year. Ultimately, this study will produce a validated, field-tested pediatric CSI risk assessment tool with recommendations for implementation. PECARN was founded in 2001 to conduct research on preventing and managing acute illnesses and injuries in children.