Validation of the TLICS and AOSpine injury score for surgical management of paediatric traumatic spinal injuries

Abstract

Introduction Fractures of the thoracolumbar spine in children are rare. Consequently, classification systems providing detailed treatment recommendations as already established in adults are still lacking in the paediatric population. We aimed to evaluate the validity and reliability of the thoracolumbar injury classification and severity score system (TLICS) and the AOSpine injury score in paediatric patients presenting with a traumatic fracture of the thoracolumbar spine. Materials and methods Patients younger than 18 years presenting with a traumatic thoracolumbar fracture at a large academic trauma centre between 2010 and 2020 were included retrospectively. Demographic and clinical data were retrieved from electronic medical reports. The AOSpine injury score and TLICS were calculated using plain radiography, magnetic resonance imaging, and/or computed tomography. Results Sixty patients with 167 fractures were included. Surgical treatment was performed in 14 patients. The mean AOSpine injury score was 1.49 ± 2.0, the mean TLICS was 1.32 ± 1.65. A significant correlation between the classification systems was found (Spearman r = 0.975, p < 0.001). Interrater reliability analysis revealed Kappa values of 0.868 for the TLICS and 0.860 for the AOSpine injury score (p < 0.001). Contingency table analysis showed a sensitivity of 1.00 and specificity of 0.94 for the AOSpine injury score and a sensitivity of 0.90 and specificity of 0.90 for the TLICS in predicting the performed treatment. Conclusions Our results confirm that the TLICS is a valid classification system for determining treatment decisions in paediatric patients and show slightly higher accuracy of the AOSpine injury score as well as high interrater reliabilities for both classification systems.

Thoracolumbar Injury Classification Systems

“…Subsequent studies at different institutions have demonstrated greater consensus in both adult and pediatric populations. [24][25][26][27][28] Ultimately, TLICS largely accomplished its primary aim: "to devise a practical, yet comprehensive, classification system for TL injuries." 15 It simultaneously presented a model more accessible than the AO/Magerl classification system, while eliminating column terminology, and making strides in reliability, validity, and influence on clinical care.…”

“…The authors attributed this discrepancy to the surgical management of stable burst fractures. Subsequent studies at different institutions have demonstrated greater consensus in both adult and pediatric populations 24–28…”