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Journal update
Journal update monthly top five
  1. Natasha Roya Matthews1,
  2. Kuroush Ardeshirian1,
  3. Emma Gold1,
  4. Thehela Harris1,
  5. Helen Mackey1,
  6. Dariush Micallef1,
  7. Jankee Patel1,
  8. Pedro Vila de Mucha1,
  9. Gabrielle Prager2
  1. 1 Emergency Department Collaborative Research Group, St George's University Hospitals NHS Foundation Trust, London, UK
  2. 2 International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Natasha Roya Matthews; natasha.matthews{at}stgeorges.nhs.uk

https://doi.org/10.1136/emermed-2024-214414

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    Introduction

    This month’s update is by the Emergency Department Collaborative Research Group, St George’s University Hospitals NHS Foundation Trust team. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.

    The papers are ranked as:

    • Worth a peek—interesting, but not yet ready for prime time.

    • Head turner—new concepts.

    • Game changer—this paper could/should change practice.

    PECARN prediction rule for cervical spine imaging of children presenting to the ED with blunt trauma: a multicentre prospective observational study by Leonard et al1

    Topic: clinical decision rules

    Outcome rating: game changer

    Accurate prediction tools for cervical spine injuries (CSI) in children are lacking. A reliable, accurate clinical decision rule (CDR) would reduce unnecessary imaging and missed significant injuries.1

    This prospective, mulitcentre, l study from the Pediatric Emergency Care Applied Research Network (PECARN), which included 22 430 children, prospectively derived and validated a CDR to detect CSI in children aged 0–17 years. Children arriving at PECARN-affiliated US level 1 paediatric trauma centres were enrolled into derivation or validation cohorts. The treating ED physicians completed a questionnaire detailing risk factors and clinical examination. CSI was based on imaging results and surgical review notes 3–4 weeks after the ED visit. The CDR identified 4 high-risk factors (p<0.15) then applying classification and regression tree analysis to identify 5 non-negligible risk factors. The three-tiered PECARN CSI prediction rule thus uses high and medium risk factors to guide imaging decision-making. In the validation cohort, it’s sensitivity was 94.3% (95% CI 90.7 to 97.9), specificity of 60.4% (59.4 to 61.3) and negative predictive value of 99.9% (99.8 to 100.0). The authors estimated that if the CDR had been applied to all participants, the proportion receiving a cervical spine CT might have decreased from 3856 (17.2%) to 1549 …

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    Footnotes

    • X @n_r_matthews, @https://x.com/drhelenmackey

    • Contributors NRM led the team and was responsible for submission. GP conducted the search. The top five papers were selected as a group. Summaries were written by KA, EG, TH, HM, DM, JP and PVdM. NRM and GP reviewed the summaries and made edits to the revisions.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.