PECARN - Pediatric Emergency Care Applied Research Network

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Pediatric Readiness Saves Lives!
New guidelines means a new nationwide assessment. Learn what’s new and get ready for the
next Pediatric Readiness assessment for EDs, opening March 2026!
https://pedsready.org/
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The End of Routine Lumbar Punctures for the Febrile Infant 28 Days and Younger? For decades, the teaching in pediatric emergency medicine has been consistent: “Young febrile infants (0-28 days) with fevers get a full sepsis workup.” This traditionally means blood, urine, and cerebrospinal fluid (CSF) cultures, followed by admission and antibiotics. The fear of missing bacterial meningitis—a devastating infection—has driven this aggressive approach. But is a lumbar puncture […]

🚨 New #PECARN Blog 🚨
“The End of Routine Lumbar Punctures for Febrile Infants ≤28 Days.” Michelle Lin, MD reviews new evidence shaping care for young infants.
Read more 👉🏼 pecarn.org/pecarn_ne...
#PRIME #Pediatrics #EM

New multicenter study in Pediatrics: When #PECARN decision rules are used for pediatric head & abdominal trauma, disparities in CT use largely disappear.

Standardized tools MATTER!

#headtrauma #PEM
@AmerAcadPeds @nkuppermann
pubmed.ncbi.nlm.nih....

🤖 #AI meets pediatric #sepsis!

New @PECARNTeam study shows machine learning models can be trained & validated to predict sepsis and #septicshock in kids—paving the way for earlier recognition & intervention.

🔗 pubmed.ncbi.nlm.nih....

#PECARN #PRIME

#PECARN CSI = pediatric-specific, EMS-validated, safer.
💪 Protect spines.
🚫 Avoid over-immobilization.
Next: real-world rollout & education.

#EMS #PediatricTrauma #PECARN

#CHaMP #GLACiER

🔗journals.lww.com/jtr...

#PECARN moves prehospital care from reflex to reason.
🚗 Not every fender bender = collar.
👦🏾 Not every kid = scan.
Evidence, not habit.

#EMS #EvidenceBased

#CHaMP #GLACiER

🔗journals.lww.com/jtr...

#PECARN flags risk with 9 total factors:
🔹 Neck pain or tenderness
🔹 Neuro deficit or altered mental status
🔹 Major head or torso trauma

No factors? → Skip the collar.

#CSpine #EMS

#CHaMP #GLACiER

🔗journals.lww.com/jtr...

Kids don’t compartmentalize trauma — energy moves through the body.

#PECARN sees the whole mechanism, not just one symptom.

#PediEMS #TraumaCare

#CHaMP #GLACiER

🔗journals.lww.com/jtr...

Traditional rules looked only at neck findings.

#PECARN adds major head or torso injury — acknowledging that big energy transfer can hurt the spine even without neck pain.

#PediatricTrauma #EMS

#CHaMP #GLACiER

🔗journals.lww.com/jtr...

If #PECARN were used prehospital:
📉 SMR 41.5% → 37.7%
📉 Longboard use 17% → 9.8%
💡 Fewer collars, less discomfort, same spine safety.

#Trauma #EMSResearch


#CHaMP #GLACiER

🔗 journals.lww.com/jtr...


#CHaMP #GLACiER

This isn’t a hospital rule retrofitted for the field.

It was tested by EMS, in real prehospital environments, across 18 sites.

#EMS #PrehospitalCare

#CHaMP #GLACiER

🔗 journals.lww.com/jtr...

Developed from 22,000+ pediatric trauma cases, now validated with EMS data.
✅ Sensitivity: 88.5%
✅ Negative predictive value: 99.7%
➡️ Accurate and safe.

#PECARN #PediEMS

#CHaMP #GLACiER

🔗journals.lww.com/jtr...

Before #PECARN, we relied on adult rules —
- NEXUS
- Canadian C-Spine Rule

👩🏽 👉🏼 👦🏻 They work for adults but weren’t built or validated for children.

#EMS #EvidenceBased

#CHaMP #GLACiER

🔗journals.lww.com/jtr...

Every child in trauma gets a collar “just in case,” but most don’t need one.

#PECARN gives EMS a pediatric-specific rule to decide who truly needs spinal motion restriction (SMR).

#PediEMS #TraumaCare

#CHaMP #GLACiER

🔗 pecarn.org/pecarn_ne...
🔗journals.lww.com/jtr...

📢 New Article!
Can AI spot which kids are at risk for sepsis before they become ill?

A @PECARNteam study led by Dr. Alpern shows machine learning models can predict #sepsis using EHR data—before it occurs

🔗 pubmed.ncbi.nlm.nih....

@LurieChildrens @ChildrensPhila #AI #PRIME

Targeted and Universal Screening Boost Gonorrhea and Chlamydia Detection in the Pediatric ED This post is a summary and discussion of the following article from JAMA Pediatrics: Reed JL, Palmer CA, Casper TC, et al. Gonorrhea and Chlamydia Screening for Adolescents and Young Adults in Emergency Departments. JAMA Pediatr. Published online September 08, 2025. doi:10.1001/jamapediatrics.2025.2139

📊In >98k teen ED visits, targeted gonorrhea & chlamydia screening found +2.59/1,000 visits and universal screening +1.81/1,000 compared with usual care.

More cases detected = more teens treated.

#PECARN #HOMERUN

👉🏼 pemcincinnati.com/bl...

🔗 jamanetwork.com/jour...

Where should research go next to improve pediatric pain care ❓

This consensus study highlights priorities like optimizing ED analgesia, reducing disparities, preventing opioid misuse, and improving long-term outcomes for kids in pain.

#HOMERUN #PECARN

🔗 pubmed.ncbi.nlm.nih....

Interrater Reliability in Pediatric Cervical Spine Assessment: Can EM Docs and Surgeons Agree? Introduction Evaluating children with blunt trauma for cervical spine injury (CSI) is a high-stakes and high-variability process. While CSI is rare, the consequences of missed injuries are serious, and so is the harm from overuse of imaging, especially CT. The PECARN CSI prediction rule is a promising tool

Good news for injured kids 🚑

Emergency & surgery teams showed strong agreement on pediatric C-spine findings w/ 64% agreement on clinical suspicion & 74% on imaging decisions

Read more on PEMBlog: http://bit.ly/483Jys3 🔗 pubmed.ncbi.nlm.nih....
@nkuppermann @JCLeonardMDMPH

#HOMERUN

Protecting adolescent health ❤️📱

Confidential surveys + smart EHR alerts improved STI screening in the ED. Over 6k teens participated and providers acknowledged alerts 82% of the time.

🔗 pubmed.ncbi.nlm.nih....

#HOMERUN

Kids in pain deserve better ❤️‍🩹

Experts identified the top 10 research questions to improve pain care for children in the ED, including better ED and home pain relief, integrative treatments, equity, opioid safety, and more.

#PECARN #HOMERUN

🔗 pubmed.ncbi.nlm.nih....

Interrater Reliability in Pediatric Cervical Spine Assessment: Can EM Docs and Surgeons Agree? Introduction Evaluating children with blunt trauma for cervical spine injury (CSI) is a high-stakes and high-variability process. While CSI is rare, the consequences of missed injuries are serious, and so is the harm from overuse of imaging, especially CT. The PECARN CSI prediction rule is a promising tool

How well do EM and surgical teams agree on pediatric cervical spine assessment ❓

This PECARN study found moderate to substantial agreement on key findings and imaging decisions.

Read more on PEMBlog: http://bit.ly/483Jys3

🔗 pubmed.ncbi.nlm.nih....

#HOMERUN

🧪IF you draw labs on a febrile 61-90-day-old infant, use these predictive values

✨PCT ≤ 0.24 ng/mL
✨ANC ≤ 10,710/mm³


➡️ 100% sensitivity + 100% NPV for IBIs.


Next step: Prospective validation before widespread use

#PRIME

There is practice variability re: labs for febrile👶 61-90d
#PECARN asked, who is low risk for IBI?

CART analysis to ID low-risk infants:
🧪 UA negative 🌡️ Tmax ≤38.9°C

➡️ NPV ~99.5% for IBI
⚠️ But ~1% (14 infants) w/ IBI would be missed
👉 pubmed.ncbi.nlm.nih....
#ID

#PRIME

🚨 Hot off the #PECARN press!
👶An approach to fever in the 61-90d infant

Study evaluated:
🧪 ~5k infants w/ blood + urine drawn (17 EDs)

➡️ 2% invasive bacterial infection (IBI)
• 1.9% bacteremia (no meningitis)
• 0.1% meningitis
👉 pubmed.ncbi.nlm.nih....

@nkuppermann

#PRIME

Quick reminder: imaging rules

Consider CT Factors
- GCS 3-8
- unresponsive on AVPU
- Abnormal ABC's
- Focal neuro deficit

Consider XR Factors
- Neck pain
- GCS 9-14 / AVPU V or P
- Substantial torso
- Substantial head injuries
- Midline neck TTP

This rule has a high sensitivity and negative predictive value

If applied to the study group, CT use would decrease by more than 50% without missing important injury!

Thanks for participating!
Correct answer: A - no imaging

The new PECARN c-spine imaging clinical algorithm provides guidance about who should get imaging & what kind - taking into account 9 clinical risk factors

✨Mechanism of injury is not included

www.mdcalc.com/calc/10552/p...

A 12 y/o M presents after an MVC, +airbag deployment. He experienced "whiplash". He has a mild HA, no neck pain. Exam: GCS 15, nml neuro exam, no neck pain, +full ROM. What imaging do you order?

1️⃣ No Imaging
2️⃣ Neck XR
3️⃣ CT Neck
4️⃣ Other

📊 Show results

Did you know @pecarn.bsky.social has a blog?

Current posts include:

🧠 AI for community perspectives in clinical trials
💨 Magnesium dosing in pediatric asthma
🩸 Arginine for sickle cell disease pain treatment

Check out pecarn.org/news for the latest! #PedsEM