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.

In adults, high quality evidence-based neck injury clinical decision rules (CDRs) can help determine which patients should receive neck imaging. Similar CDRs are not available in children. Based on our pilot data, current neck imaging rates for children post trauma in Australia are high and variable (>=60%) yet radiographical abnormalities are found in few. It is therefore imperative that we determine the best CDR for neck imaging in children.

This study aims to:
(i) investigate the accuracy of existing 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

The study will be conducted at PREDICT sites in Australia and New Zealand. We will collaborate with the PECARN team led by Dr Julie Leonard from the Research Institute at Nationwide Children’s Hospital, Ohio, USA, who is leading the validation of the PECARN neck injury rule in the USA.

The study results will have bi-national impact in Australian and New Zealand EDs in optimising the management of neck injured children – improving the detection of spinal cord, bone and ligamentous injuries and minimising unnecessary imaging.

Study design

Multicentre, prospective observational study

Chief Investigators

Franz Babl (Co-ordinating Principal Investigator)
Natalie Phillips (Deputy Principal Investigator)
Ed Oakley (Principal Investigator)
Stuart Dalziel (Principal Investigator)
Meredith Borland (Principal Investigator)
Stacy Goergen (Principal Investigator)
Geoff Askin (Principal Investigator)
Gavin Davis (Principal Investigator)
Julie Leonard (Principal Investigator)
Nate Kuppermann (Principal Investigator)
Also see Site PIs under Site Locations


2020 – 2025


Medical Research Futures Fund (ANZ)
Emergency Medicine Foundation (QLD)
WA Child Research Fund (WA)

Site locations

  • Royal Children’s Hospital, Melbourne, VIC (PI Franz Babl)
  • Perth Children’s Hospital, WA (PI Meredith Borland)
  • Starship Children’s Hospital, NZ (PI Stuart Dalziel)
  • Monash Health, VIC (PI Simon Craig)
  • Women’s and Children’s Hospital, Adelaide, SA (PI Amit Kochar)
  • Queensland Children’s Hospital, QLD (PI Natalie Phillips)
  • Sunshine Coast University Hospital, QLD (PI Michelle Davison)
  • Gold Coast University Hospital, QLD (PI Shane George)
  • Logan Hospital, QLD (PI Ben Lawton)
  • Sydney Children’s Hospital, NSW (PI Arjun Rao)
  • The Children’s Hospital at Westmead, NSW (PI Blessy John-Denny)
  • Kidz First Middlemore Hospital, NZ (PI Eunicia Tan)
  • The Royal Darwin Hospital, NT (PI Clare Mitchell)


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


Clinical trials registration

Trial Registration: ACTRN12621001050842