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Pediatric Cervical Spine Injury Following Blunt Trauma in Children Younger Than 3 Years: The PEDSPINE II Study
Casey M Luckhurst1, Holly M Wiberg2, Rebeccah L Brown3
1Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston.
Insights
This study developed a new prediction model to reduce unnecessary cervical spine imaging in pediatric blunt trauma patients. The model demonstrated superior accuracy in identifying injuries, potentially lowering costs and radiation exposure.
Area of Science:
- Pediatric Trauma Care
- Diagnostic Imaging
- Clinical Prediction Modeling
Background:
- Significant variability exists in diagnosing cervical spine injuries (CSI) in pediatric blunt trauma patients.
- Current imaging practices lead to increased costs, radiation exposure, and potential overdiagnosis.
Purpose of the Study:
- Develop and validate a prediction model to guide cervical spine imaging in pediatric blunt trauma.
- Identify trends in imaging utilization and evaluate the performance of the PEDSPINE model.
Main Methods:
- A retrospective cohort study of 9389 pediatric patients (<3 years) with blunt trauma across 15 centers.
- Development of a multiclass classification algorithm using clinical criteria.
- Validation of the PEDSPINE II model and comparison with the original PEDSPINE score.
Main Results:
- The PEDSPINE II study included 9389 patients, with a CSI rate of 1.36%.
- 80% of patients underwent cervical spine imaging, an increase from the prior PEDSPINE study.
- The PEDSPINE II model achieved a superior AUC of 0.885 for predicting any injury compared to the PEDSPINE score (AUC 0.845).
Conclusions:
- Clinical variability in evaluating pediatric blunt trauma patients leads to increased imaging use.
- The developed prediction tool can aid clinical decision-making, reduce imaging utilization, and lower associated costs and radiation exposure.
- The PEDSPINE II model demonstrates improved accuracy in identifying CSI in pediatric blunt trauma.
Importance:
There is variability in practice and imaging usage to diagnose cervical spine injury (CSI) following blunt trauma in pediatric patients.
Objective:
To develop a prediction model to guide imaging usage and to identify trends in imaging and to evaluate the PEDSPINE model.
Design, Setting, And Participants:
This cohort study included pediatric patients (<3 years years) following blunt trauma between January 2007 and July 2017. Of 22 centers in PEDSPINE, 15 centers, comprising level 1 and 2 stand-alone pediatric hospitals, level 1 and 2 pediatric hospitals within an adult hospital, and level 1 adult hospitals, were included. Patients who died prior to obtaining cervical spine imaging were excluded. Descriptive analysis was performed to describe the population, use of imaging, and injury patterns. PEDSPINE model validation was performed. A new algorithm was derived using clinical criteria and formulation of a multiclass classification problem. Analysis took place from January to October 2022.
Exposure:
Blunt trauma.
Main Outcomes And Measures:
Primary outcome was CSI. The primary and secondary objectives were predetermined.
Results:
The current study, PEDSPINE II, included 9389 patients, of which 128 (1.36%) had CSI, twice the rate in PEDSPINE (0.66%). The mean (SD) age was 1.3 (0.9) years; and 70 patients (54.7%) were male. Overall, 7113 children (80%) underwent cervical spine imaging, compared with 7882 (63%) in PEDSPINE. Several candidate models were fitted for the multiclass classification problem. After comparative analysis, the multinomial regression model was chosen with one-vs-rest area under the curve (AUC) of 0.903 (95% CI, 0.836-0.943) and was able to discriminate between bony and ligamentous injury. PEDSPINE and PEDSPINE II models' ability to identify CSI were compared. In predicting the presence of any injury, PEDSPINE II obtained a one-vs-rest AUC of 0.885 (95% CI, 0.804-0.934), outperforming the PEDSPINE score (AUC, 0.845; 95% CI, 0.769-0.915).
Conclusion And Relevance:
This study found wide clinical variability in the evaluation of pediatric trauma patients with increased use of cervical spine imaging. This has implications of increased cost, increased radiation exposure, and a potential for overdiagnosis. This prediction tool could help to decrease the use of imaging, aid in clinical decision-making, and decrease hospital resource use and cost.
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