Pedemy All toolsAnswer one question at a time. High-risk factors lead to CT; other risk factors to X-rays; none to clinical clearance. Tap any earlier answer to change it.
This tool applies the 2024 PECARN cervical spine rule to help clinicians decide whether a child aged 0–17 years with blunt trauma needs a CT of the neck, plain X-rays, or no imaging. It does not apply to purely penetrating trauma, which is routed to trauma surgery.
The rule asks first about high-risk factors: altered mental status with a GCS of 3–8 or unresponsiveness on AVPU, abnormal airway, breathing or circulation, and a focal neurological deficit. Any one of these points to CT; about 13% of these children have a neck injury. If none is present, the tool asks about neck pain, milder altered mental status (GCS 9–14), substantial head or torso injury, and midline neck tenderness. Any of these points to plain X-rays rather than CT. If none of the factors is present, the neck can be cleared clinically, with a negative predictive value of 99.9% in validation.
Each result includes next steps, such as keeping the collar until the spine is cleared, padding under the shoulders in children under 8 years, MRI for deficits or persistent symptoms, and how to clear the neck at the bedside. The rule is from Leonard et al., Lancet Child Adolesc Health 2024.
It is a 2024 prediction rule for children 0–17 years with blunt trauma. High-risk factors (GCS 3–8 or unresponsive, abnormal ABCs, focal neuro deficit) lead to CT. Other factors (neck pain, GCS 9–14, substantial head or torso injury, midline tenderness) lead to X-rays. With none, the neck is cleared clinically.
When there is no high-risk factor but the child has neck pain, altered mental status with GCS 9–14, substantial head or torso injury, or midline neck tenderness. The tool suggests AP and lateral views, adding an odontoid view if the child can cooperate, and CT only if X-rays are abnormal or inadequate.
With none of the PECARN factors, the collar can be removed when the child is alert with no midline tenderness, no pain and full painless active range of motion. If pain or tenderness appears with movement, the collar goes back on and X-rays are obtained.
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