Current Environment:


Cervical spine injuries (CSI) are serious, but rare events in children. Spinal precautions (rigid cervical collar and immobilization on a longboard) in the prehospital setting may be beneficial for children with CSI, but are poorly studied. In contrast, spinal precautions for pediatric trauma patients without CSI are common and may be associated with harm. Spinal precautions result in well-documented adverse physical and physiological sequelae. Of substantial concern is that the mere presence of prehospital spinal precautions may lead to a cascade of events that results in the increased use of inappropriate radiographic testing in the emergency department (ED) to evaluate children for CSI and thus an unnecessary, increased exposure to ionizing radiation and lifetime risk of cancer. Most children who receive spinal precautions and/or are imaged for potential CSI, and particularly those imaged with computed tomography (CT), are exposed to potential harm with no demonstrable benefit. Therefore, there is an urgent need to develop a Pediatric CSI Risk Assessment Tool that can be used in the prehospital and ED settings to reduce the number of children who receive prehospital spinal precautions inappropriately and are imaged unnecessarily while identifying all children who are truly at risk for CSI.


Cervical Spine Injury

Recruitment Status


Eligibility Criteria

Inclusion Criteria:

Age 0-17 years
Known or suspected exposure to blunt trauma

At least one of the following applies to the patient:

Undergoing trauma team evaluation
Transported from the scene to participating facility by EMS
Undergoing cervical spine imaging at participating facility
Transferred to participating facility with cervical spine imaging

Exclusion Criteria:

Exposed to solely penetrating trauma (e.g. a gunshot or stab wound)



Min Age


Max Age

18 Years

Download Date

February 22, 2024

Principal Investigator

Lois K. Lee

This field has been modified from to show a contact specific to Boston Children's.

Primary Contact Information

Lois K Lee, MD, MPH

This field has been modified from to show a contact specific to Boston Children's.

For more information on this trial, visit


For more information and to contact the study team:

Development and Testing of a Pediatric Cervical Spine Injury Risk Assessment Tool NCT05049330 Lois K Lee, MD, MPH 617-355-6624