Is there a paediatric clinical prediction rule with an algorithm that can advise on the X-ray decision for cervical spine injury among children in the emergency department? This clinical situation happens every day in every emergency department around the world. We do not want to expose children to ionising radiation unnecessarily. Leonard C et al (The Lancet Child & Adolescent Health 2024;8:482–490. https://doi.org/10.1016/S2352-4642(24)00104-4) report a prospective observational cohort study where they have screened 22, 340 children aged 0–17 years presenting with known or suspected blunt trauma. This is a Pediatric Emergency Care Applied Research Network study, using 18 of …