Project Snapshot – SONIC study

Study of Neck Injury Imaging in Children (SONIC): Improving the Diagnosis of Spinal Cord, Bone and Ligament Injuries

Many children sustain head and neck trauma during their lifetime. Significant neck injuries – to spinal cord, neck bones and connecting ligaments – can be identified by performing neck imaging with x-rays, or, if needed, computed tomography or magnetic resonance imaging. Yet, it is unclear which children should receive neck imaging in the emergency department (ED), especially in the context of increasing concerns about radiation-induced cancer in children and the discomfort and delays of immobilisation prior to imaging.

This study aims to:

(i) investigate the accuracy of existing neck injury clinical decision rules (CDRs) to detect neck injuries in children (external validation) of adult focussed CDRs and the newly developed paediatric PECARN CDR
(ii) derive and validate a new CDR for neck imaging in children (the SONIC CDR),
(iii) assess the cost implications of different CDRs in children.
(iv) investigate the epidemiology of cervical spine injuries in ANZ.

Study design:

Multicentre, prospective observational study.


2020 – 2025

  • Royal Children’s Hospital, Melbourne (VIC)
  • Monash Children’s Hospital, Melbourne (VIC)
  • Queensland Children’s Hospital (QLD)
  • Logan Hospital (QLD)
  • Sunshine Coast University Hospital (QLD)
  • Gold Coast University Hospital (QLD)
  • Perth Children’s Hospital, Perth (WA)
  • Children’s Hospital at Westmead (NSW)
  • Sydney Children’s Hospital (NSW)
  • Women’s and Children’s Hospital, Adelaide (SA)
  • Darwin Hospital (NT)
  • Kids First, Auckland (NZ)
  • Starship Children’s Hospital, Auckland (NZ)

PREDICT ~30,000 (depending on prevalence of injuries), children aged <16 yrs with possible neck


Recruitment has commenced at 8 Australian sites (Royal Children’s Hospital, Melbourne, Queensland Children’s Hospital, Perth Children’s Hospital, Women’s and Children’s Hospital, Adelaide and Darwin Hospital, Gold Coast and Sunshine Coast University Hospitals and Monash Hospital Victoria, with over 1000 patients enrolled to date.

Governance approvals are underway for the remaining 3 Australian sites with hopes to commence recruitment at these in the coming weeks. We are also awaiting final ethics approval for NZ and hope to commence site education and recruitment in the coming months and therefore having all 13 sites in full recruitment mode before the end of the year!