Clinical clearance of the cervical spine in blunt trauma patients younger than 3 years: A multi-center study of the American association for the surgery of trauma

Authors

Rafael Pieretti-Vanmarcke, Massachusetts General Hospital, United States
George C. Velmahos, Massachusetts General Hospital, United States
Michael L. Nance, Children’s Hospital of Philadelphia, United States
Saleem Islam, University of Mississippi Medical Center, United States
Richard A. Falcone Jr,, University of Cincinnati, United States
Paul W. Wales, Hospital for Sick Children, Canada
Rebeccah L. Brown, University of Cincinnati, United States
Barbara A. Gaine, Children’s Hospital, United States
Christine McKenna, Children’s Hospital, United States
Forrest O. Moore, St. Joseph’s Medical Center, United States

Document Type

Article

Department

Paediatric Surgery

Abstract

Background: Cervical spine clearance in the very young child is challenging. Radiographic imaging to diagnose cervical spine injuries (CSI) even in the absence of clinical findings is common, raising concerns about radiation exposure and imaging-related complications. We examined whether simple clinical criteria can be used to safely rule out CSI in patients younger than 3 years.
Methods: The trauma registries from 22 level I or II trauma centers were reviewed for the 10-year period (January 1995 to January 2005). Blunt trauma patients younger than 3 years were identified. The measured outcome was CSI. Independent predictors of CSI were identified by univariate and multivariate analysis. A weighted score was calculated by assigning 1, 2, or 3 points to each independent predictor according to its magnitude of effect. The score was established on two thirds of the population and validated using the remaining one third.
Results: Of 12,537 patients younger than 3 years, CSI was identified in 83 patients (0.66%), eight had spinal cord injury. Four independent predictors of CSI were identified: Glasgow Coma Score <14, GCSEYE = 1, motor vehicle crash, and age 2 years or older. A score of <2 had a negative predictive value of 99.93% in ruling out CSI. A total of 8,707 patients (69.5% of all patients) had a score of <2 and were eligible for cervical spine clearance without imaging. There were no missed CSI in this study.
Conclusions: CSI in patients younger than 3 years is uncommon. Four simple clinical predictors can be used in conjunction to the physical examination to substantially reduce the use of radiographic imaging in this patient population.

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

The Journal of Trauma: Injury, Infection, and Critical Care

Recommended Citation

Pieretti-Vanmarcke, R., Velmahos, G. C., Nance, M. L., Islam, S., Falcone Jr,, R. A., Wales, P. W., Brown, R. L., Gaine, B. A., McKenna, C., Moore, F. O. (2009). Clinical clearance of the cervical spine in blunt trauma patients younger than 3 years: A multi-center study of the American association for the surgery of trauma. The Journal of Trauma: Injury, Infection, and Critical Care, 67(3), 543-549.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_paediatr/160