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The sensitivity and negative predictive value of a pediatric cervical spine clearance algorithm that minimizes

Mary Arbuthnot1, David P Mooney1

  • 1Boston Children's Hospital, Department of Surgery, Harvard Medical School, 300 Longwood Ave, Fegan 3, Boston, MA 02115.

Journal of Pediatric Surgery
|December 3, 2016
PubMed

Insights

This study found a pediatric cervical spine clearance algorithm has high sensitivity (94.4%) and negative predictive value (99.9%) for identifying injuries in children, reducing unnecessary imaging.

Area of Science:

  • Pediatric Emergency Medicine
  • Trauma Surgery
  • Radiology

Background:

  • Minimizing ionizing radiation exposure is critical in pediatric trauma care.
  • Accurate identification of cervical spine injuries in children is essential.
  • Existing clearance protocols require validation for pediatric populations.

Purpose of the Study:

  • To evaluate the sensitivity and negative predictive value of a pediatric cervical spine clearance algorithm.
  • To assess the algorithm's effectiveness in reducing advanced imaging utilization.
  • To determine the algorithm's performance across different age groups within the pediatric population.

Main Methods:

  • Retrospective review of children (<21 years) admitted after blunt trauma over 10 years.
  • Data extraction included demographics, injury codes, cervical collar use, Injury Severity Score, and imaging type.
  • Sensitivity and negative predictive value of the cervical spine clearance algorithm were calculated.

Main Results:

  • The algorithm was applied to 1023 pediatric patients who arrived in a cervical collar without advanced imaging.
  • Sensitivity was 94.4% and negative predictive value was 99.9%.
  • One case of a missed spinous process tip fracture was identified in a teenager.

Conclusions:

  • The pediatric cervical spine clearance algorithm demonstrates high accuracy in identifying injuries.
  • The algorithm is associated with a low missed injury rate and reduced computed tomography (CT) utilization.
  • Effective even in very young children (<3 years), supporting its clinical utility.
Abstract

Keywords:
AlgorithmCervical spineCtPediatricRadiationTrauma

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