Comparison of Cervical Spine Injury Prediction Rule Across Ages.

objectiveTo 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.

methodsWe 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.

resultsThere 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.

conclusionsRule 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.