Factors Associated With Cervical Spine Injury in Children After Blunt Trauma

Leonard, Julie C.; Kuppermann, Nathan; Olsen, Cody S.; Babcock, Lynn; Brown, Kathleen M.; Mahajan, Prashant; Adelgais, Kathleen; Anders, Jennifer; Borgialli, Dominic; Donoghue, Aaron; Hoyle, John D.; Kim, Emily; Leonard, Jeffrey R.; Lillis, Kathleen; Nigrovic, Lise E.; Powell, Elizabeth C.; Rebella, Greg; Reeves, Scott D.; Rogers, Alexander; Stankovic, Curt; Teshome, Getachew; Jaffe, David M.

doi:10.1016/j.annemergmed.2010.08.038

Cited by 137 publications

(108 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…2 Briefly, children (<16 years old) presenting to 17 PECARN hospitals between January 1, 2000, and December 31, 2004, who underwent cervical spine imaging were identified retrospectively through query of hospital billing databases. Cases were confirmed as CSI and control patients were confirmed to be free of CSI.…”

Section: Study Setting and Populationmentioning

confidence: 99%

“…1 A retrospective chart review involving 3,314 children experiencing blunt trauma was undertaken by the Pediatric Emergency Care Applied Research Network (PECARN) and identified potential predictors of pediatric CSI. 2 Although the PECARN CSI study employed methods of performing high-quality medical chart reviews described by Gilbert et al, 3 retrospective data extraction requires a degree of interpretation of medical records by data abstractors. The results of the PECARN CSI study depend on the validity of the abstracted data.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Interobserver Agreement in Retrospective Chart Reviews for Factors Associated With Cervical Spine Injuries in Children

Olsen

Kuppermann

Jaffe

et al. 2015

Academic Emergency Medicine

Self Cite

View full text Add to dashboard Cite

Objectives: The objective was to describe the interobserver agreement between trained chart reviewers and physician reviewers in a multicenter retrospective chart review study of children with cervical spine injuries (CSIs).Methods: Medical records of children younger than 16 years old with cervical spine radiography from 17 Pediatric Emergency Care Applied Research Network (PECARN) hospitals from years 2000 through 2004 were abstracted by trained reviewers for a study aimed to identify predictors of CSIs in children. Independent physician-reviewers abstracted patient history and clinical findings from a random sample of study patient medical records at each hospital. Interobserver agreement was assessed using percent agreement and the weighted kappa (j) statistic, with lower 95% confidence intervals.Results: Moderate or better agreement (j > 0.4) was achieved for most candidate CSI predictors, including altered mental status (j = 0.87); focal neurologic findings (j = 0.74); posterior midline neck tenderness (j = 0.74); any neck tenderness (j = 0.89); torticollis (j = 0.79); complaint of neck pain (j = 0.83); history of loss of consciousness (j = 0.89); nonambulatory status (j = 0.74); and substantial injuries to the head (j = 0.50), torso/trunk (j = 0.48), and extremities (j = 0.59). High-risk mechanisms showed near-perfect agreement (diving, j = 1.0; struck by car, j = 0.93; other motorized vehicle crash, j = 0.93; fall, j = 0.92; high-risk motor vehicle collision, j = 0.89; hanging, j = 0.80). Fair agreement was found for clotheslining mechanisms (j = 0.36) and substantial face injuries (j = 0.40).Conclusions: Most retrospectively assessed variables thought to be predictive of CSIs in blunt traumainjured children had at least moderate interobserver agreement, suggesting that these data are sufficiently valid for use in identifying potential predictors of CSI.ACADEMIC EMERGENCY MEDICINE 2015;22:487-491

show abstract

Section: Study Setting and Populationmentioning

confidence: 99%

mentioning

confidence: 99%

Interobserver Agreement in Retrospective Chart Reviews for Factors Associated With Cervical Spine Injuries in Children

Olsen

Kuppermann

Jaffe

et al. 2015

Academic Emergency Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…2 The institutional review boards for each participating site and the data coordinating center approved this study.…”

Section: Methodsmentioning

confidence: 99%

“…5,6 The Pediatric Emergency Care Applied Research Network (PECARN; Participating Centers and Investigators 3 are listed in Appendix A) CSI study was a large, multicenter, retrospective case-control study to identify risk factors for CSIs in children. 2 In the primary analysis, we identified eight patient history and physical examination findings associated with CSIs in children: altered mental status, focal neurologic findings, complaint of neck pain, torticollis, substantial torso injury, predisposing conditions, diving, and high-risk motor vehicle crash (MVC). Subsequent secondary analyses of this pediatric CSI cohort demonstrated substantial age-related variation in mechanisms and patterns of CSI.…”

mentioning

confidence: 99%

“…1 Prior large, prospective investigations and primary source reviews aimed at developing risk stratification strategies for CSI evaluation to restrict potentially harmful interventions have been limited by few children with CSIs, especially children younger than 8 years. [1][2][3][4][5] Inclusion of young children in studies of CSI is important, as children are exposed to different mechanisms of injury throughout childhood and undergo developmental anatomical changes that influence CSI patterns. 5,6 The Pediatric Emergency Care Applied Research Network (PECARN; Participating Centers and Investigators 3 are listed in Appendix A) CSI study was a large, multicenter, retrospective case-control study to identify risk factors for CSIs in children.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Age‐related Differences in Factors Associated With Cervical Spine Injuries in Children

Leonard

Jaffe

Olsen

et al. 2015

Academic Emergency Medicine

Self Cite

View full text Add to dashboard Cite

Objectives: The Pediatric Emergency Care Applied Research Network (PECARN) investigators previously identified risk factors associated with cervical spine injuries (CSIs) in children. Anatomic maturation and age-related variation in mechanisms of injury suggested the need to explore factors separately for younger versus older children. The purpose of this substudy was to investigate CSI risk factors in age subgroups within the PECARN study cohort.Methods: This was an age-stratified case-control analysis of children younger than 16 years presenting to 17 PECARN hospitals following blunt trauma between January 1, 2000 and December 31, 2004. Data were abstracted for children with CSIs and randomly selected CSI-free children. Age-stratified multivariable logistic regression was performed to identify factors associated with CSI within three age groups: younger than 2, 2 to 7, and 8 to 15 years. Sensitivity and specificity for CSI were estimated for both the age-specific and original (altered mental status, focal neurologic findings, neck pain, torticollis, substantial torso injury, predisposing conditions, diving, and high-risk motor vehicle crash [MVC]) models.Results: Among 540 children with CSIs, 27 were younger than 2 years, 140 were 2 to 7 years, and 373 were 8 to 15 years. Focal neurologic deficits and high-risk MVC were associated with CSIs in all agespecific models. Other age-specific factors included the following: younger than 2 years, none; 2 to 7 years, altered mental status, neck pain, torticollis; and 8 to 15 years, altered mental status, neck pain, diving. Age-specific models had comparable sensitivity to the original model among the older groups, but had lower sensitivity and higher specificity among the youngest children.Conclusions: While this analysis supports the original PECARN model for CSI, there were subtle age variations in factors associated with CSIs in children that warrant future investigation.ACADEMIC EMERGENCY MEDICINE 2015;22:441-446

show abstract

Pediatric Cervical Spine Injury Following Blunt Trauma in Children Younger Than 3 Years

Luckhurst,

Wiberg,

Brown

et al. 2023

JAMA Surg

View full text Add to dashboard Cite

ImportanceThere is variability in practice and imaging usage to diagnose cervical spine injury (CSI) following blunt trauma in pediatric patients.ObjectiveTo develop a prediction model to guide imaging usage and to identify trends in imaging and to evaluate the PEDSPINE model.Design, Setting, and ParticipantsThis cohort study included pediatric patients (&lt;3 years years) following blunt trauma between January 2007 and July 2017. Of 22 centers in PEDSPINE, 15 centers, comprising level 1 and 2 stand-alone pediatric hospitals, level 1 and 2 pediatric hospitals within an adult hospital, and level 1 adult hospitals, were included. Patients who died prior to obtaining cervical spine imaging were excluded. Descriptive analysis was performed to describe the population, use of imaging, and injury patterns. PEDSPINE model validation was performed. A new algorithm was derived using clinical criteria and formulation of a multiclass classification problem. Analysis took place from January to October 2022.ExposureBlunt trauma.Main Outcomes and MeasuresPrimary outcome was CSI. The primary and secondary objectives were predetermined.ResultsThe current study, PEDSPINE II, included 9389 patients, of which 128 (1.36%) had CSI, twice the rate in PEDSPINE (0.66%). The mean (SD) age was 1.3 (0.9) years; and 70 patients (54.7%) were male. Overall, 7113 children (80%) underwent cervical spine imaging, compared with 7882 (63%) in PEDSPINE. Several candidate models were fitted for the multiclass classification problem. After comparative analysis, the multinomial regression model was chosen with one-vs-rest area under the curve (AUC) of 0.903 (95% CI, 0.836-0.943) and was able to discriminate between bony and ligamentous injury. PEDSPINE and PEDSPINE II models’ ability to identify CSI were compared. In predicting the presence of any injury, PEDSPINE II obtained a one-vs-rest AUC of 0.885 (95% CI, 0.804-0.934), outperforming the PEDSPINE score (AUC, 0.845; 95% CI, 0.769-0.915).Conclusion and RelevanceThis study found wide clinical variability in the evaluation of pediatric trauma patients with increased use of cervical spine imaging. This has implications of increased cost, increased radiation exposure, and a potential for overdiagnosis. This prediction tool could help to decrease the use of imaging, aid in clinical decision-making, and decrease hospital resource use and cost.

show abstract

Factors Associated With Cervical Spine Injury in Children After Blunt Trauma

Cited by 137 publications

References 28 publications

Interobserver Agreement in Retrospective Chart Reviews for Factors Associated With Cervical Spine Injuries in Children

Interobserver Agreement in Retrospective Chart Reviews for Factors Associated With Cervical Spine Injuries in Children

Age‐related Differences in Factors Associated With Cervical Spine Injuries in Children

Pediatric Cervical Spine Injury Following Blunt Trauma in Children Younger Than 3 Years

Contact Info

Product

Resources

About