Cervical spine injuries (CSI) are serious, but rare events in children. In contrast, spinal immobilization for transport of pediatric trauma patients followed by radiographic clearance in the emergency department (ED) is common and known to be associated with adverse effects. As a result, more than 99% of immobilized children have no CSI and are exposed to harm with no demonstrable benefit. The nation's EMS systems need a set of CSI screening criteria that can be applied in both the prehospital and ED settings to reduce the number of children who are immobilized and irradiated unnecessarily. The Pediatric Emergency Care Applied Research Network (PECARN) has identified 8 sensitive risk factors that predict cervical spine injury in children. These risk factors require prospective evaluation prior to implementation as a decision support tool. The logical next step in preparation for this large multi-center study is to establish the feasibility of collecting paired observations of CSI rsk factors from EMS providers and emergency physicians. Goal: Develop and test the infrastructure necessary for collecting prospective observational data from EMS providers and emergency physicians who care for children with blunt trauma as a prerequisite for conducting a large prospective study to refine and validate a Pediatric CSI Risk Assessment Tool.
Specific Aims : 1) To construct a data collection system for prehospital provider and emergency physician observations of children who receive medical care after blunt trauma. 2) To identify a set of variables for the assessment of CSI in children that are easy and reliable to use by both prehospital providers and emergency physicians. 3) To validate a set of variables as independent predictors of CSI in children when observed prospectively. Coordination: This work will be conducted at 3 level-one pediatric trauma centers and their affiliated EMS- systems within the PECARN Hospitals of the Midwest Emergency Research Node (HOMERUN): St. Louis Children's Hospital, Cincinnati Children's Medical Center, and Children's Hospital of Wisconsin. Methodology: Each study site will form a research team that will engage EMS personnel in developing the necessary research materials and methods for collecting prospective observational data from EMS prehospital providers and emergency physicians regarding cervical spine injury risk factors in children. We will pilot test the materials and methods on a sample of 3,000 injured children who are transported to HOMERUN emergency departments for evaluation following blunt trauma. Evaluation: We will track missed eligible patients and report the capture rates for EMS provider and emergency physician observations. We will also compare the characteristics of those enrolled to the missed eligible patients. We will report measures of inter-rater agreement for all paired EMS provider and physician observations. For 10% of the sample, we will report these measures for paired physician-physician and EMS provider-provider observations. We will report the predictive value of the variables that are under consideration for incorporation into a Pediatric CSI Risk Assessment Tool.

Public Health Relevance

This project uses study sites within a pre-existing research network to develop the infrastructure necessary to conduct a large; prospective observational study which engages EMS prehospital providers and emergency physicians in the development of a Pediatric Cervical Spine Injury (CSI) Risk Assessment Tool. Such a tool can be used to determine which injured children can be safely transported without spinal immobilization and forgo radiographic evaluation in the emergency department. This project has the potential to benefit millions of injured children at negligible risk for CSI; but who are subject to the unnecessary harms of immobilization and/or neck irradiation.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Exploratory/Developmental Grants (R21)
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Health Services Organization and Delivery Study Section (HSOD)
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Tamburro, Robert F
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Nationwide Children's Hospital
United States
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