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Factors associated with cervical spine injury in children after blunt trauma
Julie C Leonard1, Nathan Kuppermann, Cody Olsen
1Department of Pediatrics, Division of Emergency Medicine, School of Medicine, Washington University in St. Louis, St. Louis Children's Hospital, One Children's Place, St. Louis, MO 63110, USA. leonard_ju@kids.wustl.edu
Insights
Identifying risk factors for cervical spine injury in children after blunt trauma is crucial. An 8-factor model was developed to aid in safely limiting imaging and immobilization for pediatric patients.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Radiology
Background:
- Cervical spine injuries are rare in children but often lead to extensive imaging and immobilization.
- Current risk factor models are designed for adults, not children, necessitating pediatric-specific guidelines.
- Immobilization and radiography in children carry potential adverse effects.
Purpose of the Study:
- To identify specific risk factors for cervical spine injury in children following blunt trauma.
- To develop a predictive model for pediatric cervical spine injury.
- To inform clinical decision-making regarding imaging and immobilization in pediatric trauma.
Main Methods:
- A case-control study was conducted involving children under 16 years old with blunt trauma.
- Data were collected from 17 hospitals within the Pediatric Emergency Care Applied Research Network (PECARN) between 2000 and 2004.
- Multiple logistic regression analyses identified predictors of cervical spine injury, with sensitivity and specificity calculated.
Main Results:
- Eight factors were associated with cervical spine injury in children: altered mental status, focal neurologic findings, neck pain, torticollis, substantial torso injury, predisposing conditions, diving, and high-risk motor vehicle crashes.
- The presence of one or more factors demonstrated 98% sensitivity and 26% specificity for cervical spine injury.
- Similar risk factors were identified across different control group analyses.
Conclusions:
- An 8-variable model for predicting cervical spine injury in children after blunt trauma has been identified.
- This model requires prospective refinement and validation for clinical application.
- The findings aim to improve the safe and judicious use of imaging and immobilization in pediatric trauma care.
Study Objective:
Cervical spine injuries in children are rare. However, immobilization and imaging for potential cervical spine injury after trauma are common and are associated with adverse effects. Risk factors for cervical spine injury have been developed to safely limit immobilization and radiography in adults, but not in children. The purpose of our study is to identify risk factors associated with cervical spine injury in children after blunt trauma.
Methods:
We conducted a case-control study of children younger than 16 years, presenting after blunt trauma, and who received cervical spine radiographs at 17 hospitals in the Pediatric Emergency Care Applied Research Network (PECARN) between January 2000 and December 2004. Cases were children with cervical spine injury. We created 3 control groups of children free of cervical spine injury: (1) random controls, (2) age and mechanism of injury-matched controls, and (3) for cases receiving out-of-hospital emergency medical services (EMS), age-matched controls who also received EMS care. We abstracted data from 3 sources: PECARN hospital, referring hospital, and out-of-hospital patient records. We performed multiple logistic regression analyses to identify predictors of cervical spine injury and calculated the model's sensitivity and specificity.
Results:
We reviewed 540 records of children with cervical spine injury and 1,060, 1,012, and 702 random, mechanism of injury, and EMS controls, respectively. In the analysis using random controls, we identified 8 factors associated with cervical spine injury: altered mental status, focal neurologic findings, neck pain, torticollis, substantial torso injury, conditions predisposing to cervical spine injury, diving, and high-risk motor vehicle crash. Having 1 or more factors was 98% (95% confidence interval 96% to 99%) sensitive and 26% (95% confidence interval 23% to 29%) specific for cervical spine injury. We identified similar risk factors in the other analyses.
Conclusion:
We identified an 8-variable model for cervical spine injury in children after blunt trauma that warrants prospective refinement and validation.
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