 In general, the diagnostic evaluation of children with traumatic spine injury is determined by clinical findings, such as pain, limitation of movements, and neurological deficits, as well as injury mechanisms (eg, high- versus low-energy trauma mechanisms) [6]. However, the clinical assessment of spine injuries in children may be limited in unconscious or intubated patients, in children with intellectual disabilities, and in children who lack the ability to communicate because of their developmental stage (typically <2 years of age) [7,8]. Two major clinical decision rules, the National Emergency X-Radiography Utilization Study (NEXUS) criteria [13] and the Canadian C-Spine Rule [14], were demonstrated to have high negative predictive values (97% and 100%, respectively) to rule out cervical spine injury in adults without the need for imaging. The first NEXUS validation study [15] included children, but the sample size was small and there were few young children with cervical spine injury and none <2 years of age. A later pediatric validation study showed that no clinically important injuries were missed when the NEXUS clinical decision rule was used [16]; however, this validation study was also limited by a low incidence of cervical spine injury and small numbers of very young children [17]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org The Pediatric Emergency Care Applied Research Network (PECARN) study identified risk factors associated with cervical spine injury in children in a large case control study [18].
Suspected Spine Trauma Child PCAs.  In general, the diagnostic evaluation of children with traumatic spine injury is determined by clinical findings, such as pain, limitation of movements, and neurological deficits, as well as injury mechanisms (eg, high- versus low-energy trauma mechanisms) [6]. However, the clinical assessment of spine injuries in children may be limited in unconscious or intubated patients, in children with intellectual disabilities, and in children who lack the ability to communicate because of their developmental stage (typically <2 years of age) [7,8]. Two major clinical decision rules, the National Emergency X-Radiography Utilization Study (NEXUS) criteria [13] and the Canadian C-Spine Rule [14], were demonstrated to have high negative predictive values (97% and 100%, respectively) to rule out cervical spine injury in adults without the need for imaging. The first NEXUS validation study [15] included children, but the sample size was small and there were few young children with cervical spine injury and none <2 years of age. A later pediatric validation study showed that no clinically important injuries were missed when the NEXUS clinical decision rule was used [16]; however, this validation study was also limited by a low incidence of cervical spine injury and small numbers of very young children [17]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org The Pediatric Emergency Care Applied Research Network (PECARN) study identified risk factors associated with cervical spine injury in children in a large case control study [18].