Katie W Russell, Anastasia M Kahan, R Scott Eldredge, Robert A Swendiman, Zachary J Kastenberg, Annika B Kay, John W Rampton, Kelly Huynh, Hsuan-Yu Wan, David S Morris, Rajiv R Iyer, Vijay M Ravindra, Douglas L Brockmeyer
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We hypothesized that CT would be highly sensitive for detecting CSIs across a diverse network of hospitals.</p><p><strong>Methods: </strong>A retrospective cohort study of pediatric patients younger than 18 years with trauma diagnosis codes who underwent CS imaging within 24 hours of presentation to an emergency department was conducted across a mixed adult and pediatric 23-hospital system from January 2012 through December 2023. A clinically significant CSI was defined as an injury requiring CS surgery or halo placement within 7 days of presentation. Patients who underwent CT and had a clinically significant CSI were compared with those without.</p><p><strong>Results: </strong>A total of 14,232 pediatric trauma patients were evaluated with CS CTs. An additional 10,900 with minor trauma were screened with x-ray and no CT. Of patients who underwent CT, 109 (0.8%) had CSIs. On univariate analysis, CSI patients were more likely to be obtunded shown by an increase in intubation (19% vs. 5%, p < 0.001), and a Glasgow Coma Scale score of <14 (22% vs. 6%, p = 0.049). Four patients with CSIs had normal CTs per initial radiographic report. Post hoc analysis by an expert spine panel identified abnormalities on all CTs. The sensitivity of CT for diagnosing CSI was 96%, and the negative predictive value was 100%. This was consistent across all age groups.</p><p><strong>Conclusion: </strong>Computed tomography has a high sensitivity for detecting clinically significant CSIs in pediatric trauma patients across all ages and a wide variety of hospitals. Consideration must be given to clearing the pediatric CS based on a negative CT in the absence of symptoms.</p><p><strong>Level of evidence: </strong>Retrospective Cohort Study; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"An analysis of potential cervical spine clearance in children with computed tomography alone.\",\"authors\":\"Katie W Russell, Anastasia M Kahan, R Scott Eldredge, Robert A Swendiman, Zachary J Kastenberg, Annika B Kay, John W Rampton, Kelly Huynh, Hsuan-Yu Wan, David S Morris, Rajiv R Iyer, Vijay M Ravindra, Douglas L Brockmeyer\",\"doi\":\"10.1097/TA.0000000000004667\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Clearance of the pediatric cervical spine (CS) after trauma remains a challenge. 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Patients who underwent CT and had a clinically significant CSI were compared with those without.</p><p><strong>Results: </strong>A total of 14,232 pediatric trauma patients were evaluated with CS CTs. An additional 10,900 with minor trauma were screened with x-ray and no CT. Of patients who underwent CT, 109 (0.8%) had CSIs. On univariate analysis, CSI patients were more likely to be obtunded shown by an increase in intubation (19% vs. 5%, p < 0.001), and a Glasgow Coma Scale score of <14 (22% vs. 6%, p = 0.049). Four patients with CSIs had normal CTs per initial radiographic report. Post hoc analysis by an expert spine panel identified abnormalities on all CTs. The sensitivity of CT for diagnosing CSI was 96%, and the negative predictive value was 100%. 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引用次数: 0
摘要
儿童颈椎外伤后的清除仍然是一个挑战。虽然错过伤病是不可接受的，但长时间的固定也是有害的。我们的目的是确定计算机断层扫描（CT）的敏感性和阴性预测值，以确定在大型卫生系统中儿科钝性创伤患者的临床显著颈椎损伤（CSIs）。我们假设CT对于在不同的医院网络中检测csi是高度敏感的。方法：2012年1月至2023年12月，在23家医院的成人和儿科混合系统中，对年龄小于18岁的创伤诊断编码的儿童患者进行回顾性队列研究，这些患者在急诊就诊后24小时内接受了CS成像。具有临床意义的CSI被定义为在出现后7天内需要CS手术或放置光晕的损伤。接受CT检查并有临床显著CSI的患者与未接受CT检查的患者进行比较。结果：14232例儿童创伤患者接受CS ct评估。另外10,900名轻微创伤患者进行了x线检查，没有进行CT检查。在接受CT检查的患者中，109例（0.8%）有CSIs。单变量分析显示，插管次数增加（19% vs. 5%, p < 0.001）表明CSI患者更有可能发生昏迷，格拉斯哥昏迷量表评分为：结论：计算机断层扫描在所有年龄和各种医院的儿科创伤患者中检测临床显著的CSIs具有很高的敏感性。在没有症状的情况下，必须考虑在CT阴性的基础上清除儿童CS。证据水平：回顾性队列研究；IV级。
An analysis of potential cervical spine clearance in children with computed tomography alone.
Introduction: Clearance of the pediatric cervical spine (CS) after trauma remains a challenge. While missing an injury is unacceptable, prolonged immobilization is also detrimental. We aimed to determine the sensitivity and negative predictive value of computed tomography (CT) for the identification of clinically significant cervical spine injuries (CSIs) in pediatric blunt trauma patients across a large health system. We hypothesized that CT would be highly sensitive for detecting CSIs across a diverse network of hospitals.
Methods: A retrospective cohort study of pediatric patients younger than 18 years with trauma diagnosis codes who underwent CS imaging within 24 hours of presentation to an emergency department was conducted across a mixed adult and pediatric 23-hospital system from January 2012 through December 2023. A clinically significant CSI was defined as an injury requiring CS surgery or halo placement within 7 days of presentation. Patients who underwent CT and had a clinically significant CSI were compared with those without.
Results: A total of 14,232 pediatric trauma patients were evaluated with CS CTs. An additional 10,900 with minor trauma were screened with x-ray and no CT. Of patients who underwent CT, 109 (0.8%) had CSIs. On univariate analysis, CSI patients were more likely to be obtunded shown by an increase in intubation (19% vs. 5%, p < 0.001), and a Glasgow Coma Scale score of <14 (22% vs. 6%, p = 0.049). Four patients with CSIs had normal CTs per initial radiographic report. Post hoc analysis by an expert spine panel identified abnormalities on all CTs. The sensitivity of CT for diagnosing CSI was 96%, and the negative predictive value was 100%. This was consistent across all age groups.
Conclusion: Computed tomography has a high sensitivity for detecting clinically significant CSIs in pediatric trauma patients across all ages and a wide variety of hospitals. Consideration must be given to clearing the pediatric CS based on a negative CT in the absence of symptoms.
Level of evidence: Retrospective Cohort Study; Level IV.
期刊介绍：
The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.
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