Triage tools for detecting cervical spine injury in pediatric trauma patients

Slaar, Annelie; Fockens, M. Matthijs; Wang, Junfeng; Maas, Mario; Wilson, David J.; Goslings, J. Carel; Schep, N.W.L.; Rijn, Rick R. van

doi:10.1002/14651858.cd011686

Cited by 13 publications

(21 citation statements)

References 62 publications

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“…In agreement with the recent Cochrane review, the development of a CDR for C‐spine imaging has been identified as a high priority in a recent PREDICT network Delphi study . PREDICT has previously conducted a large multicentre study to determine the best head injury imaging CDR, and data in the current study will underpin the planning for a similar study around neck injuries.…”

Section: Discussionmentioning

confidence: 57%

“…In adults, two high‐quality CDRs from North America – the Canadian C‐spine Rule (CCR) and US National Emergency X‐Radiography Low Risk Criteria (NEXUS) – help doctors decide whether or not diagnostic imaging is needed in adults with blunt trauma in the ED. A recent Cochrane review of retro‐ and prospective studies to determine the paediatric accuracy of CCR and NEXUS in children found that there was either insufficient evidence (CCR) or conflicting evidence (NEXUS) to support the use of either rule in children and called for ‘additional well‐designed studies with large sample sizes…to better evaluate the accuracy of the NEXUS criteria or the CCR, or both’.…”

Section: Introductionmentioning

confidence: 99%

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Clinical clearance and imaging for possible cervical spine injury in children in the emergency department: A retrospective cohort study

Hopper

McKenna

Williams

et al. 2019

Emerg Medicine Australasia

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Objectives While cervical spine injuries (CSIs) are rare in the paediatric population, presentations to EDs with possible neck injuries are common. Based on a lack of Australian data we set out to determine how many possible injuries are clinically cleared, what imaging is used on the remainder and the incidence and characteristics of confirmed paediatric CSIs. Methods We undertook a retrospective electronic medical record review of children <18 years with potential CSIs at a large tertiary paediatric trauma centre in Victoria, Australia over a 12 month period (annual census 87 000). For possible injuries we extracted key epidemiologic, imaging and short‐term outcome data. Results During the study period, a total of 617 patients with potential neck injuries were seen in the ED (617/87 000, 0.7%). The median age was 11 years. The most common mechanisms of injury were falls (41%), motor vehicle injuries (28%) and sports‐related injuries (24%). Four hundred and fourteen of 617 (67%) underwent neck imaging (345/414, 83% plain radiograph; 100/414, 24% computed tomography; 7/414, 1.6% magnetic resonance imaging). Twenty‐three of 617 (4.1%) had radiologically documented CSIs. Two required operative interventions for their neck injuries. Conclusion While two‐thirds of children with potential CSIs undergo radiological evaluation, actual injuries are rare (<4%). These data suggest that there is a potential for improved targeting of cervical spine imaging for trauma. The development of a clinical decision tool may help reduce neck radiography.

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Section: Discussionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Clinical clearance and imaging for possible cervical spine injury in children in the emergency department: A retrospective cohort study

Hopper

McKenna

Williams

et al. 2019

Emerg Medicine Australasia

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“…This case report demonstrates that for pediatric patients with neck pain and risk of atlanto-axial subluxation and/or instability, CT should be used first [11]. By missing the critical diagnosis of C1-C2 subluxation by using a radiograph, there was delayed diagnosis and treatment.…”

Section: Discussionmentioning

confidence: 95%

“…A variety of angles is required for adequate visualization of the bony contours of the cervical spine, including lateral, anteroposterior, and open-mouth views [10]. Radiography's sensitivity of around 90% for detection of bony cervical spine injuries makes it an adequate screening method for patients who show no apparent neurological abnormalities [11]. However, the popular cervical spine imaging modality remains the CT scan, with a 98-100% sensitivity for detecting cervical spine injury [9,11].…”

Section: Discussionmentioning

confidence: 99%

“…Radiography's sensitivity of around 90% for detection of bony cervical spine injuries makes it an adequate screening method for patients who show no apparent neurological abnormalities [11]. However, the popular cervical spine imaging modality remains the CT scan, with a 98-100% sensitivity for detecting cervical spine injury [9,11]. By defining the location and orientation of displaced bone relative to the spinal canal, CT scans' high resolution allows for accurate cervical spine abnormality detection.…”

Section: Discussionmentioning

confidence: 99%

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C1-C2 Subluxation after Mild Cervical Spine Trauma in a Child

Snee¹,

Mazzola²

2020

SCR

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We report a case of a seven-year-old girl who presented with a “Cock-Robin” head tilt and cervical spine injury after falling from her bed. Initial cervical spine X-ray reported a fractured clavicle. However, almost four weeks later, the torticollis had not resolved. Computerized tomography (CT) of the cervical spine revealed subluxation of the atlanto-axial joint at C1-C2. Cervical spine magnetic resonance imaging (MRI) did not show any spinal cord injury. Manual reduction and hard collar placement were attempted, yet C1- C2 subluxation recurred. The child was placed into halo traction and then into a halo vest. CT scan showed near complete resolution of C1-C2 subluxation. Three months later the halo device was removed, and the patient was placed in a hard cervical collar then transitioned into a soft collar over a four month period. During this time, the patient received physical therapy. Final cervical spine radiographs revealed proper cervical spine alignment and resolution of C1-C2 subluxation.

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

Luckhurst,

Wiberg,

Brown

et al. 2023

JAMA Surg

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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.

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Triage tools for detecting cervical spine injury in pediatric trauma patients

Abstract: Triage tools for detecting cervical spine injury in pediatric trauma patients (Review)

Cited by 13 publications

References 62 publications

Clinical clearance and imaging for possible cervical spine injury in children in the emergency department: A retrospective cohort study

Clinical clearance and imaging for possible cervical spine injury in children in the emergency department: A retrospective cohort study

C1-C2 Subluxation after Mild Cervical Spine Trauma in a Child

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

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