Injury Prediction Rule Could Decrease Radiographic Imaging Exposure in Children, Study Shows

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(COLUMBUS, Ohio) – While cervical spine injuries (CSI) are uncommon in children, they can be potentially devastating, resulting in quadriplegia – paralysis below the neck affecting both arms and both legs. Detecting CSIs in a clinical setting often requires imaging such as X-rays and computed tomography (CT) scans, both of which expose children to radiation, which can cause other health issues over time.

In a study published today in The Lancet Child & Adolescent Health, researchers in the Pediatric Emergency Care Applied Research Network (PECARN) – led by Julie Leonard, MD, MPH at Nationwide Children’s Hospital –created a highly accurate cervical spine injury prediction rule. When applied, the rule decreases the use of CT by more than 50% without missing clinically significant injuries or increasing normal X-ray use.  

“Emergency medical professionals prioritize thoroughness to ensure no serious injuries are overlooked, a crucial aspect in caring for every trauma patient,” said Dr. Leonard, an emergency medicine physician at Nationwide Children’s. “However, we also understand the age-related radiation sensitivity and malignancy risk caused by use of CT, and we’re very encouraged that this new prediction rule could reduce some of that unnecessary exposure.”

The study required the collaboration of 18 children’s hospitals to enroll more than 22,000 study participants over a period of three years. The resulting PECARN CSI prediction rule is easy for physicians to use, relying solely on a child’s symptoms and physical examination upon arrival in the emergency department. The prediction consists of nine clinical findings, four of which designate a child as “high-risk” for CSI and appropriate for initial screening with CT.

“More research needs to be completed to determine how best to implement this rule into community emergency department settings, where most children are evaluated after trauma” said Dr. Leonard, who is the principal investigator of the Great Lakes Atlantic Children’s Emergency Research node (GLACiER) of the PECARN. “We are hoping that this rule can empower families to collaborate even more closely with their children’s care teams for better clinical outcomes.”

About the Great Lakes Atlantic Children’s Emergency Research (GLACiER) Node of the Pediatric Emergency Care Applied Research Network (PECARN)
GLACiER is one of seven nodes nationwide funded for research in pediatric emergency care, part of PECARN. The node includes Nationwide Children’s Hospital (Columbus, OH), University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh (Pittsburgh, PA), and Nemours Children’s Hospital (Wilmington, DE). PECARN conducts high-quality, multicenter research into the prevention and management of acute illnesses and injuries in children. Its research spans across the continuum of emergency care from prehospital to hospital settings. PECARN is funded by the federal Emergency Medical Services for Children (EMSC) program, part of the Health Resources and Services Administration. EMSC aims to ensure that—no matter where a child lives—the health systems in their area provide quality emergency care services. More information about GLACiER is available at

This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; 5R01HD091347 Development and Testing of a Pediatric Cervical Spine Injury Risk Assessment Tool)

Federal funding statement: PECARN is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of awards totaling $4,950,000 with 0% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, visit

NOTE TO JOURNALISTS: Post-embargo access to the study can be found here.

About The Abigail Wexner Research Institute at Nationwide Children's Hospital
Named to the Top 10 Honor Roll on U.S. News & World Report’s 2023-24 list of “Best Children’s Hospitals,” Nationwide Children’s Hospital is one of America’s largest not-for-profit free-standing pediatric health care systems providing unique expertise in pediatric population health, behavioral health, genomics and health equity as the next frontiers in pediatric medicine, leading to best outcomes for the health of the whole child.  Integrated clinical and research programs are part of what allows Nationwide Children’s to advance its unique model of care. As home to the Department of Pediatrics of The Ohio State University College of Medicine, Nationwide Children’s faculty train the next generation of pediatricians, scientists and pediatric specialists. The Abigail Wexner Research Institute at Nationwide Children’s Hospital is one of the Top 10 National Institutes of Health-funded free-standing pediatric research facilities in the U.S., supporting basic, clinical, translational, behavioral and population health research. The AWRI is comprised of multidisciplinary Centers of Emphasis paired with advanced infrastructure supporting capabilities such as technology commercialization for discoveries; gene- and cell-based therapies; and genome sequencing and analysis. More information is available at


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