Category: EMS
Keywords: MVC, c-spine injury, PECARN, rules (PubMed Search)
Posted: 4/15/2026 by Jenny Guyther, MD
(Updated: 4/20/2026)
Click here to contact Jenny Guyther, MD
Cervical spine injuries (CSI) are uncommon in children, but when present, they are often devastating. However, the application of a cervical collar in children is not benign and adverse effects include neck pain and discomfort and the downward tunnel vision it may create at the hospital leading to unnecessary testing. Recently, the PECARN group published a set of criteria to determine who requires imaging of the cervical spine in the emergency department. A planned subset of this initial study was to collect the impressions of EMS as they pertained to the 9 criteria to determine if these criteria could safely be used by EMS. The patients who were brought in by EMS with the potential for cervical spine injury, who were evaluated by the trauma team and/or had cervical imaging AND had electronic case reports filled out by EMS were included in the final analysis. Only 57% of the patients possible could be included based on the number of electronic case reports that were filled out.
Overall, when the criteria were applied to the EMS patients based on the EMS assessment, the PECARN CSI had a sensitivity of 88.5%, a specificity of 63.1%, a PPV of 3.7% and a NPV of 99.7%.
Of 122 patients, 14 patients who did have CSI were not detected. Further analysis of these missed patients showed that 11 of the patients did have one of the 9 criteria present which was documented by the ED but not by EMS. Only one of the 14 missed patients required operative intervention. 12/14 of these patients were from motor vehicle collisions.
The study criteria did perform better in the ED setting compared to the EMS setting. Further research will need to examine if these clinical criteria can be applied to the field or if they should be modified to increase the specificity.
The 9 criteria and a brief description of the original study can be found at: https://pecarn.org/pecarn_news/clinical-decision-rule-cervical-spine/
Browne LR, Ward CE, Harding M, Cook LJ, Adelgais KM, Ahmad FA, Burger R, Chaudhari PP, Corwin DJ, Glomb NW, Kuppermann N, Lee LK, Leonard JR, Owusu-Ansah S, Riney LC, Rogers AJ, Rubalcava DM, Sapien RE, Szadkowski MA, Tzimenatos L, Yen K, Leonard JC. Performance of the PECARN cervical spine injury prediction rule based on EMS clinician observations. J Trauma Acute Care Surg. 2025 Aug 21. doi: 10.1097/TA.0000000000004772. Epub ahead of print. PMID: 40836370.
