Ahmad Fahd A, Browne Lorin R, Glomb Nicolaus W, Harding Monica, Cook Lawrence J, Burger Rebecca K, Chaudhari Pradip P, Rogers Alexander J, Ward Caleb E, Rubalcava Daniel, Yen Kenneth, Kuppermann Nathan, Leonard Julie C
From the Washington University School of Medicine in St. Louis & St. Louis Children's Hospital (F.A.A.), St. Louis, Missouri; Departments of Pediatric and Emergency Medicine (L.R.B.), Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Emergency Medicine and Pediatrics (N.W.G.), University of California, San Francisco, San Francisco, California; Division of Pediatric Emergency Medicine, Department of Emergency Medicine (M.H., L.J.C.), University of Utah School of Medicine, Salt Lake City, Utah; Division of Emergency Medicine, Department of Pediatrics (R.K.B.), Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia; Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Department of Pediatrics (P.P.C.), Keck School of Medicine of the University of Southern California, Los Angeles, California; Departments of Emergency Medicine and Pediatrics (A.J.R.), C.S. Mott Children's Hospital, University of Michigan Health, Ann Arbor, Michigan; Children's National Hospital & The George Washington University School of Medicine and Health Sciences (C.E.W.), Washington, District Columbia; Division of Pediatric Emergency Medicine, Department of Pediatrics (D.R.), Baylor College of Medicine, Texas Children's Hospital, Houston; Division of Pediatric Emergency Medicine, Department of Pediatrics (K.Y.), UT Southwestern Medical Center, Children's Health, Dallas, Texas; Departments of Pediatrics and Emergency Medicine, GW School of Medicine and Health Sciences and Children's National Hospital (N.K.), Washington D.C.; and Division of Emergency Medicine, Department of Pediatrics (J.C.L.), The Ohio State College of Medicine and Nationwide Children's Hospital, Columbus, Ohio.
J Trauma Acute Care Surg. 2025 Jun 19. doi: 10.1097/TA.0000000000004695.
Cervical spine injury (CSI) is uncommon in children but an important consideration during trauma evaluation. The Pediatric Emergency Care Applied Research Network (PECARN) derived and validated a CSI prediction rule to guide cervical spine imaging decisions in children after blunt trauma. Our objective was to determine the interrater reliability between EM providers and surgeons for history and physical examination findings used to evaluate children for CSI after blunt trauma.
This was a planned secondary analysis of a prospective, observational multicenter study that enrolled children aged 0 year to 17 years evaluated for blunt trauma in 18 PECARN emergency departments (EDs). We collected data on injury mechanisms, history and physical examination findings, imaging ordered, and suspicion of CSI from EM and surgery providers. Kappa, prevalence, and bias-adjusted kappa (PABAK) were used to compare interrater reliability of variables associated with CSI.
Surgeons cared for 8,041 of the 22,430 children enrolled in the parent study. About 18.6% (1494/8041) had data collection forms completed by both EM providers and surgeons and were included in the analysis. Agreement between EM and surgery providers per kappa was moderate (kappa 0.41-0.6) to substantial (kappa 0.61-0.8), while PABAK analyses showed substantial to almost perfect agreement for variables in the PECARN CSI prediction rule. There was agreement between EM and surgery providers in overall clinical suspicion for CSI in 64.2% (959/1494) of patients. Retrospective application of the PECARN Rule indicated that ED and surgical provider assessments would have led to the same imaging decision in 73.7% (1101/1494) of patients.
We identified moderate to substantial agreement between EM providers and surgeons for clinical findings that comprise the PECARN Cervical Spine Injury Prediction Rule. Agreement between providers during shared decision-making will strengthen the use of the prediction rule and may lead to decreased cervical spine imaging in EDs.
Prognostic and Epidemiologic; Level II.
颈椎损伤（CSI）在儿童中并不常见，但在创伤评估过程中是一个重要的考量因素。儿科急诊护理应用研究网络（PECARN）制定并验证了一项CSI预测规则，以指导钝性创伤后儿童颈椎成像决策。我们的目的是确定急诊医疗服务提供者（EM）和外科医生之间在用于评估钝性创伤后儿童CSI的病史和体格检查结果方面的评分者间信度。
这是一项对一项前瞻性观察性多中心研究的计划二次分析，该研究纳入了在18个PECARN急诊科（ED）接受钝性创伤评估的0至17岁儿童。我们收集了关于损伤机制、病史和体格检查结果、所开具的影像学检查以及EM和外科医疗服务提供者对CSI的怀疑的数据。使用kappa、患病率和偏差调整kappa（PABAK）来比较与CSI相关变量的评分者间信度。
在母研究纳入的22430名儿童中，有8041名儿童由外科医生进行治疗。约18.6%（1494/8041）的儿童有EM提供者和外科医生都填写完成的数据收集表，并被纳入分析。根据kappa，EM和外科医疗服务提供者之间的一致性为中等（kappa 0.41 - 0.6）到高度一致（kappa 0.61 - 0.8），而PABAK分析显示，对于PECARN CSI预测规则中的变量，一致性为高度一致到几乎完全一致。在64.2%（959/1494）的患者中，EM和外科医疗服务提供者在对CSI的总体临床怀疑方面达成了一致。PECARN规则的回顾性应用表明，急诊科和外科医疗服务提供者的评估在73.7%（1101/1494）的患者中会导致相同的成像决策。
我们发现EM提供者和外科医生之间在构成PECARN颈椎损伤预测规则的临床发现方面存在中等至高度的一致性。在共同决策过程中提供者之间的一致性将加强预测规则的使用，并可能导致急诊科颈椎成像减少。
预后和流行病学；二级。
