Evaluation of cervical spine clearance scores in children younger than 3 years with blunt trauma

Tej D. Azad Departments of Neurosurgery and

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Kelly Jiang Departments of Neurosurgery and

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Carly Weber-Levine Departments of Neurosurgery and

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Ryan P. Lee Departments of Neurosurgery and

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Amit Jain Orthopedics, Johns Hopkins University; and

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Paul Sponseller Orthopedics, Johns Hopkins University; and

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Mari Groves Departments of Neurosurgery and

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Nicholas Theodore Departments of Neurosurgery and

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Isam W. Nasr Division of Pediatric Surgery, Johns Hopkins University, Baltimore, Maryland

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Eric M. Jackson Departments of Neurosurgery and

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OBJECTIVE

The PEDSPINE I and PEDSPINE II scores were developed to determine when patients require advanced imaging to rule out cervical spine injury (CSI) in children younger than 3 years of age with blunt trauma. This study aimed to evaluate these scores in an institutional cohort.

METHODS

The authors identified patients younger than 3 years with blunt trauma who received cervical spine MRI from their institution’s prospective database from 2012 to 2015. Patient demographics, injury characteristics, and imaging were compared between patients with and without CSI using chi-square and Wilcoxon rank-sum tests.

RESULTS

Eighty-eight patients were identified, 8 (9%) of whom had CSI on MRI. The PEDSPINE I system had a higher sensitivity (50% vs 25%) and negative predictive value (93% vs 92%), whereas PEDSPINE II had a higher specificity (91% vs 65%) and positive predictive value (22% vs 13%). Patients with CSI missed by the scores had mild, radiologically significant ligamentous injuries detected on MRI. Both models would have recommended advanced imaging for the patient who required halo-vest fixation (risk profile: no CSI, 81.9%; ligamentous, 10.1%; osseous, 8.0%). PEDSPINE I would have prevented 52 (65%) of 80 uninjured patients from receiving advanced imaging, whereas PEDSPINE II would have prevented 73 (91%). Using PEDSPINE I, 10 uninjured patients (13%) could have avoided intubation for imaging. PEDSPINE II would not have spared any patients intubation.

CONCLUSIONS

Current cervical spine clearance algorithms are not sensitive or specific enough to determine the need for advanced imaging in children. However, these scores can be used as a reference in conjunction with physicians’ clinical impressions to reduce unnecessary imaging.

ABBREVIATIONS

CCR = Canadian C-Spine Rule; CSI = cervical spine injury; GCS = Glasgow Coma Scale; MVC = motor vehicle collision; NAT = nonaccidental trauma; NEXUS = National Emergency X-Radiography Utilization Study; NPV = negative predictive value; PPV = positive predictive value.
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