Plain Radiograph Use in Pediatric Blunt Trauma Patients with Suspicion for Cervical Spine Injury: A…

Cohort studyJournal of the American College of Surgeons· Aug 2026

Plain Radiograph Use in Pediatric Blunt Trauma Patients with Suspicion for Cervical Spine Injury: A Prospective Observational Analysis of the Western Pediatric Cervical Spine Study.

Anastasia M Kahan, Hsuan-Yu Wan, R Scott Eldredge … Western Pediatric Cervical Spine Study group

Emergency Trauma CareCohort studyDiagnosisQ1IF 1.9

Plain radiographs had near-perfect negative predictive value in appropriately selected pediatric trauma patients

Plain Radiograph Use in Pediatric Blunt Trauma Patients with Suspicion for Cervical Spine Injury: A Prospective Observational Analysis of the Western Pediatric Cervical Spine Study.

Anastasia M Kahan … Western Pediatric Cervical Spine Study group

Journal of the American College of Surgeons · Aug 2026

Background

Despite guideline support for plain radiography (XR) in low-risk pediatric blunt trauma, CT remains the predominant imaging modality for cervical spine evaluation, increasing radiation exposure.

Methods

We performed a prospective, multicenter observational study of 19,995 children enrolled in the Western Pediatric Cervical Spine Study across 72 U.

n = 19,995 children

Results

99.9%

even after selective screening, x-ray almost never missed a real injury

n = 19,995 children

More results

Among XR-appropriate children (n=12,650), an estimated 7,705 CT examinations could potentially have been replaced with XR.

In the overall cohort, XR sensitivity for any cervical spine injury was 30.3% (95% CI 26.2-34.6%) with an negative predictive value of 95.2% (95% CI 94.7-95.7%).

“

Conclusion · 1 of 2

Plain radiography is substantially underutilized in children meeting consensus criteria for XR-first imaging.

Conclusion · 2 of 2

In appropriately selected patients, XR demonstrated an negative predictive value of 99.9% for clinically significant cervical spine injury, supporting broader implementation of XR-first imaging strategies to reduce CT utilization and pediatric radiation exposure.

Plain Radiograph Use in Pediatric Blunt Trauma Patients with Suspicion for Cervical Spine Injury: A Prospective Observational Analysis of the Western Pediatric Cervical Spine Study.

Plain Radiograph Use in Pediatric Blunt Trauma Patients with Suspicion for Cervical Spine Injury: A Prospective Observational Analysis of the Western Pediatric Cervical Spine Study.

Related papers