Journal Article

Prospective observational study to assess the performance accuracy of clinical decision rules in children presenting to emergency departments with possible cervical spine injuries: the Study of Neck Injuries in Children (SONIC)

Watson, Sarah, Phillips, Natalie, Davison, Michelle, Goergen, Stacy, Tan, Eunicia, Babl, Franz E, George, Shane, John-Denny, Blessy, Chong, Shu-Ling, Rao, Arjun, Selman, Chris J, Askin, Geoffrey N, Dalziel, Stuart, Craig, Simon, Singh, Sonia, O’Brien, Sharon, Donath, Susan M, Borland, Meredith L, Wilson, Catherine L, Leonard, Julie C, Kochar, Amit, Davis, Gavin A, Williams, Amanda, Kuppermann, Nathan

2025

Overview

IntroductionPaediatric cervical spine injury (CSI) is uncommon but can have devastating consequences. Many children, however, present to emergency departments (EDs) for the assessment of possible CSI. While imaging can be used to determine the presence of injuries, these tests are not without risks and costs, including exposure to radiation and associated life-time cancer risks. Clinical decision rules (CDRs) to guide imaging decisions exist, although two of the existing rules, the National Emergency X-Radiography Low Risk Criteria and the Canadian C-Spine Rule (CCR), focus on adults and a newly developed paediatric rule from the Pediatric Emergency Care Applied Research Network (PECARN) is yet to be externally validated. This study aims to externally validate these three CDRs in children.Methods and analysisThis is a multicentre prospective observational study of children younger than 16 years presenting with possible CSI following blunt trauma to 1 of 14 EDs across Australia, New Zealand and Singapore. Data will be collected on presenting features (history, injury mechanism, physical examination findings) and management (diagnostic imaging, admission, interventions, outcomes). The performance accuracy (sensitivity, specificity, negative and positive predictive values) of three existing CDRs in identifying children with study-defined CSIs and the specific CDR defined outcomes will be determined, along with multiple secondary outcomes including CSI epidemiology, investigations and management of possible CSI.Ethics and disseminationEthics approval for the study was received from the Royal Children’s Hospital Melbourne Human Research Ethics Committee in Australia (HREC/69436/RCHM-2020) with additional approvals from the New Zealand Human and Disability Ethics Committee and the SingHealth Centralised Institutional Review Board. Findings will be disseminated through peer-reviewed publications and future management guidelines.Trial registration numberRegistration with the Australian New Zealand Clinical Trials Registry prior to the commencement of participant recruitment (ACTRN12621001050842). 50% of expected patients have been enrolled to date.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adolescent / Australia / Cervical Vertebrae - diagnostic imaging / Cervical Vertebrae - injuries / Child / Child, Preschool / Clinical Decision Rules / Decision making / Emergency Departments / Emergency medical care / Emergency Medicine / Emergency Service, Hospital / Female / Head & neck imaging / Hospitals / Humans / Infant / Injuries / Magnetic Resonance Imaging / Male / Multicenter Studies as Topic / Neck Injuries - diagnosis / Neck Injuries - diagnostic imaging / Neck pain / New Zealand / Observational studies / PAEDIATRICS / Patients / Pediatrics / Prospective Studies / Protocol / Radiation / Risk factors / Singapore / Spinal Injuries - diagnosis / Spinal Injuries - diagnostic imaging / Spine / Trauma / Wounds, Nonpenetrating - diagnostic imaging