Multicenter retrospective evaluation of the validity of the Thoracolumbar Injury Classification and Severity Score system in children

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>The Thoracolumbar Injury Classification and Severity Score (TLICS) system was developed to streamline injury assessment and guide surgical decision making. To the best of the authors' knowledge, external validation in the pediatric age group has not been undertaken prior to this report.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>This study evaluated the use of the TLICS in a large retrospective series of children and adolescents treated at 4 pediatric medical centers (Texas Children's Hospital, Children's Healthcare of Atlanta, Riley Children's Hospital, and Doernbecher Children's Hospital). A total of 147 patients treated for traumatic thoracic or lumbar spine trauma between February 1, 2002, and September 1, 2015, were included in this study. Clinical and radiographic data were evaluated. Injuries were classified using American Spinal Injury Association (ASIA) status, Denis classification, and TLICS.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>A total of 102 patients (69%) were treated conservatively, and 45 patients (31%) were treated surgically. All patients but one in the conservative group were classified as ASIA E. In this group, 86/102 patients (84%) had Denis type compression injuries. The TLICS in the conservative group ranged from 1 to 10 (mean 1.6). Overall, 93% of patients matched TLICS conservative treatment recommendations (score ≤ 3). No patients crossed over to the surgical group in delayed fashion.</jats:p> <jats:p>In the surgical group, 26/45 (58%) were ASIA E, whereas 19/45 (42%) had neurological deficits (ASIA A, B, C, or D). One of 45 (2%) patients was classified with Denis type compression injuries; 25/45 (56%) were classified with Denis type burst injuries; 14/45 (31%) were classified with Denis type seat belt injuries; and 5/45 (11%) were classified with Denis type fracture-dislocation injuries. The TLICS ranged from 2 to 10 (mean 6.4). Eighty-two percent of patients matched TLICS surgical treatment recommendations (score ≥ 5). No patients crossed over to the conservative management group. Eight patients (8/147, 5%) had a calculated TLICS of 4, which meant they were candidates for surgery or conservative therapy by TLICS criteria. Excluding these patients, the degree of agreement between TLICS and surgeon decision was deemed to be very good (κ = 0.878).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The TLICS results and recommendations matched treatment in 96% of conservative group cases. In the surgical group, TLICS recommendations matched treatment in 93% of cases. The TLICS recommendations and surgeon decision making displayed very good concordance. The TLICS appears to be effective in the classification of thoracic and lumbar spine injuries and in guiding treatment in the pediatric age group.</jats:p></jats:sec>

The reliability of the AOSpine Thoracolumbar Spine Injury Classification System in children: An international validation study

“…There are several studies that have validated the use of TLICs in the paediatric population. [6][7][8] The AOSpine Thoracolumbar Spine Injury Classification System aims to improve and adapt key accepts of the classifications that came before it. Building off of the AO Magerl classification and TLICS, it is the result of the work of surgeons in the AOSpine Classification group in the AOSpine Knowledge Forum.…”

“…TLICS has been validated in several studies as a reliable classification system in the paediatric population. [6][7][8] In a previous study, TLICS and the AOSpine Thoracolumbar Spine Injury Classification system has been found to corelate when assessed in the peadiatric population. 9 The lead authors of this study previously assessed the inter-and intraobserver reliability of the AOSpine Thoracolumbar Spine Injury Classification System in children with a single country cohort of observers.…”

Thoracolumbar Injury Classification and Severity Score in children: a reliability study

“…Furthermore, a potential conflict of interest stems from the inclusion of the original authors of the TLICS system, which is the case in numerous studies assessing TLICS in adults. 8,15,[21][22][23][24]26 Sellin et al published the second study on TLICS in children, 29 but they did not discuss or assess the reliability of the TLICS in pediatrics, and made no reference to the only reported reliability statistics on TLICS in pediatrics as found in the study by Savage et al This is of consequence because reliability is a necessary condition for validity. 11 Furthermore, the raters in this study were not blinded to treatment.…”

“…15,33 To date, only 2 studies assessing the use of the TLICS system in children have been published. 27,29 Only 1 study considered the reliability of the scoring system in addition to its validity. 27 The purpose of our study was to evaluate the interrater reliability of the TLICS system in a large cohort of pediatric patients.…”

Çocukluk yaş döneminin torakolomber ve lomber omurga kırıkları

“…Sellin ve ark., TLICS sınıflamasının çocuk hastalarda uygulanabilirliğine yönelik 102 hastadan oluşan çok merkezli bir çalışma sonucunda, TLICS skorları ile tedaviye karar verme arasında yüksek bir uyumluluk buldular ve çocukluk dönemi torakolomber kırıkların tedavisi için kullanılabileceğini önerdiler. [27] AO (Association for Osteosynthesis) sınıflaması uygulama açısında zorluk taşıyabilmektedir. Pek çok yazar Denis'in üç kolon sınıflamasını tercih edebilmektedir.…”