William Starr, Stephanie Iantorno, Jing Wang, Richard Eldredge, Rajiv Iyer, Karch Smith, Natalya McNamara, Kezlyn Larsen, Stephen Fenton, Robert Swendiman, Katie Russell
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引用次数: 0
Abstract
Objectives: Cervical spine (c-spine) X-ray (XR) remains an important tool for pediatric trauma patients. XR is a low radiation alternative to multidetector CT (MDCT). Our primary aims were to analyze the sensitivity of a negative c-spine XR and to analyze what factors lead to additional imaging after a negative c-spine XR.
Methods: A retrospective cohort study was conducted at a level 1 pediatric trauma center from 2012 to 2021. We compared the group with negative c-spine XR and no additional imaging to the group with negative c-spine XR followed by additional c-spine MDCT and/or MRI.
Results: There were 2,081 negative XRs and 1,974 (95%) had their c-spines cleared without additional imaging. No patient required an operation for a clinically significant c-spine injury in this group, and we consider this no missed injuries. The remaining 108 patients had additional c-spine imaging after negative c-spine XR for c-spine clearance (24 MDCT, 76 MRI, 8 MDCT and MRI). Indications for additional c-spine imaging were pain (48.1%), Glasgow Coma Scale (GCS) score ≤14 (43.5%), and paresthesia (8.3%). Patients who received additional imaging were more likely to have a GCS score ≤12 (25.4% vs 4.1%), Injury Severity Score >15 (21.9% vs 8.1%), Level 1 Trauma activation (21% vs 5%), Abbreviated Injury Scale head score of 4 or 5 (29% vs 5%), be intubated (30% vs 2%), and have non-accidental trauma as their mechanism of injury (20% vs 1%) (p value<0.0001, for all). Five patients who received additional imaging were treated with a cervical collar, but no operative intervention.
Conclusions: In this cohort, screening XR had a sensitivity of 100% for clinically significant c-spine injuries. GCS was the most significant predictor of obtaining additional imaging. A negative XR combined with a normal physical examination in an evaluable pediatric patient is a safe way of clearing the c-spine.
Level of evidence: Study contains level III evidence.
目的：颈椎（c-spine） x线（XR）仍然是儿科创伤患者的重要工具。XR是一种低辐射的多探测器CT （MDCT）替代品。我们的主要目的是分析阴性c-脊柱x光检查的敏感性，并分析导致阴性c-脊柱x光检查后额外成像的因素。方法：2012 - 2021年在某一级儿科创伤中心进行回顾性队列研究。我们将颈椎x光检查阴性且未进行额外影像学检查的组与颈椎x光检查阴性并进行额外颈椎MDCT和/或MRI检查的组进行了比较。结果：2081例x光片阴性，1974例（95%）颈椎清除，无需额外影像学检查。本组中没有患者因临床意义重大的颈椎损伤而需要手术，我们认为这没有遗漏的损伤。其余108例患者在x线造影阴性后进行了额外的颈椎显像以检查颈椎间隙（MDCT 24例，MRI 76例，MDCT和MRI 8例）。额外的c-脊柱影像学指征是疼痛（48.1%），格拉斯哥昏迷评分(GCS)≤14分（43.5%）和感觉异常（8.3%）。接受额外影像学检查的患者更有可能出现GCS评分≤12 （25.4% vs 4.1%）、损伤严重程度评分bbb15 （21.9% vs 8.1%）、1级创伤激活（21% vs 5%）、简略损伤量表头部评分为4或5 （29% vs 5%）、插管（30% vs 2%）以及非意外损伤机制（20% vs 1%） （p值）。结论：在本队列中，筛查XR对临床显著的颈椎损伤的敏感性为100%。GCS是获得额外影像学检查的最重要预测指标。在可评估的儿科患者中，阴性x光片结合正常体格检查是清除颈椎的安全方法。证据等级：研究包含III级证据。
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