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Thoracolumbar Injury Classification and Severity Score in children: a reliability study.

Ross L Dawkins1, Joseph H Miller2, Omar I Ramadan1

  • 11Section of Pediatric Neurosurgery, Children's of Alabama, Department of Neurosurgery, and.

Journal of Neurosurgery. Pediatrics
|January 13, 2018
PubMed
Summary
This summary is machine-generated.

The Thoracolumbar Injury Classification and Severity Score (TLICS) shows good reliability for pediatric thoracolumbar fractures. However, caution is advised when using MRI for surgical decisions in children.

Keywords:
CI = confidence intervalICC = intraclass correlation coefficientMVA = motor vehicle accidentOR = odds ratioPLC = posterior ligamentous complexTLICS = Thoracolumbar Injury Classification and Severity Scorechildrenfracturereliabilityscorespinethoracolumbartrauma

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Area of Science:

  • Orthopedics
  • Pediatric Traumatology
  • Spinal Surgery

Background:

  • Numerous classification systems exist for thoracolumbar spine injuries.
  • The Thoracolumbar Injury Classification and Severity Score (TLICS) is a validated tool for adult patients.
  • The reliability of the TLICS in pediatric populations requires further investigation.

Purpose of the Study:

  • To evaluate the interrater reliability of the Thoracolumbar Injury Classification and Severity Score (TLICS) in pediatric patients with acute, traumatic thoracolumbar fractures.
  • To compare TLICS-determined treatment recommendations with actual treatment received.
  • To assess the impact of imaging modalities (CT and MRI) on TLICS reliability and treatment concordance.

Main Methods:

  • Retrospective review of medical records for pediatric patients with thoracolumbar fractures.
  • Calculation of TLICS scores by five independent raters using CT and MRI data.
  • Comparison of TLICS-suggested treatment with actual treatment provided.
  • Statistical analysis of interrater reliability using Fleiss' generalized kappa (κ).

Main Results:

  • Eighty-one pediatric patients were included (mean age 10.9 years).
  • The overall interrater reliability for TLICS treatment suggestion was good (κ = 0.69).
  • Interrater reliability decreased when MRI was incorporated into the TLICS calculation (κ = 0.57 for MRI-only vs. 0.73 for CT-only).
  • Agreement between TLICS-suggested and actual treatment was poorer with MRI use.

Conclusions:

  • The TLICS system demonstrates good interrater reliability for guiding thoracolumbar fracture treatment in pediatric patients.
  • Physicians should exercise caution when utilizing MRI findings within the TLICS framework for pediatric surgical decision-making.
  • Further research may be needed to refine the TLICS for optimal use in pediatric spinal trauma assessment.