Cervical spine injury risk factors in children with blunt trauma

Julie C. Leonard, Lorin R. Browne, Fahd A. Ahmad, Hamilton Schwartz, Michael Wallendorf, Jeffrey R. Leonard, E. Brooke Lerner, Nathan Kuppermann

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: Adult prediction rules for cervical spine injury (CSI) exist; however, pediatric rules do not. Our objectives were to determine test accuracies of retrospectively identified CSI risk factors in a prospective pediatric cohort and compare them to a de novo risk model. METHODS: We conducted a 4-center, prospective observational study of children 0 to 17 years old who experienced blunt trauma and underwent emergency medical services scene response, trauma evaluation, and/or cervical imaging. Emergency department providers recorded CSI risk factors. CSIs were classified by reviewing imaging, consultations, and/or telephone follow-up. We calculated bivariable relative risks, multivariable odds ratios, and test characteristics for the retrospective risk model and a de novo model. RESULTS: Of 4091 enrolled children, 74 (1.8%) had CSIs. Fourteen factors had bivariable associations with CSIs: diving, axial load, clotheslining, loss of consciousness, neck pain, inability to move neck, altered mental status, signs of basilar skull fracture, torso injury, thoracic injury, intubation, respiratory distress, decreased oxygen saturation, and neurologic deficits. The retrospective model (high-risk motor vehicle crash, diving, predisposing condition, neck pain, decreased neck mobility (report or exam), altered mental status, neurologic deficits, or torso injury) was 90.5% (95% confidence interval: 83.9%–97.2%) sensitive and 45.6% (44.0%–47.1%) specific for CSIs. The de novo model (diving, axial load, neck pain, inability to move neck, altered mental status, intubation, or respiratory distress) was 92.0% (85.7%–98.1%) sensitive and 50.3% (48.7%–51.8%) specific. CONCLUSIONS: Our findings support previously identified pediatric CSI risk factors and prospective pediatric CSI prediction rule development.

Original languageEnglish (US)
Article numbere20183221
JournalPediatrics
Volume144
Issue number1
DOIs
StatePublished - Jan 1 2019

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Spine
Wounds and Injuries
Diving
Neck Pain
Pediatrics
Torso
Neck
Neurologic Manifestations
Intubation
Basilar Skull Fracture
Thoracic Injuries
Unconsciousness
Emergency Medical Services
Motor Vehicles
Telephone
Observational Studies
Hospital Emergency Service
Referral and Consultation
Odds Ratio
Prospective Studies

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Leonard, J. C., Browne, L. R., Ahmad, F. A., Schwartz, H., Wallendorf, M., Leonard, J. R., ... Kuppermann, N. (2019). Cervical spine injury risk factors in children with blunt trauma. Pediatrics, 144(1), [e20183221]. https://doi.org/10.1542/peds.2018-3221

Cervical spine injury risk factors in children with blunt trauma. / Leonard, Julie C.; Browne, Lorin R.; Ahmad, Fahd A.; Schwartz, Hamilton; Wallendorf, Michael; Leonard, Jeffrey R.; Brooke Lerner, E.; Kuppermann, Nathan.

In: Pediatrics, Vol. 144, No. 1, e20183221, 01.01.2019.

Research output: Contribution to journalArticle

Leonard, JC, Browne, LR, Ahmad, FA, Schwartz, H, Wallendorf, M, Leonard, JR, Brooke Lerner, E & Kuppermann, N 2019, 'Cervical spine injury risk factors in children with blunt trauma', Pediatrics, vol. 144, no. 1, e20183221. https://doi.org/10.1542/peds.2018-3221
Leonard JC, Browne LR, Ahmad FA, Schwartz H, Wallendorf M, Leonard JR et al. Cervical spine injury risk factors in children with blunt trauma. Pediatrics. 2019 Jan 1;144(1). e20183221. https://doi.org/10.1542/peds.2018-3221
Leonard, Julie C. ; Browne, Lorin R. ; Ahmad, Fahd A. ; Schwartz, Hamilton ; Wallendorf, Michael ; Leonard, Jeffrey R. ; Brooke Lerner, E. ; Kuppermann, Nathan. / Cervical spine injury risk factors in children with blunt trauma. In: Pediatrics. 2019 ; Vol. 144, No. 1.
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abstract = "BACKGROUND: Adult prediction rules for cervical spine injury (CSI) exist; however, pediatric rules do not. Our objectives were to determine test accuracies of retrospectively identified CSI risk factors in a prospective pediatric cohort and compare them to a de novo risk model. METHODS: We conducted a 4-center, prospective observational study of children 0 to 17 years old who experienced blunt trauma and underwent emergency medical services scene response, trauma evaluation, and/or cervical imaging. Emergency department providers recorded CSI risk factors. CSIs were classified by reviewing imaging, consultations, and/or telephone follow-up. We calculated bivariable relative risks, multivariable odds ratios, and test characteristics for the retrospective risk model and a de novo model. RESULTS: Of 4091 enrolled children, 74 (1.8{\%}) had CSIs. Fourteen factors had bivariable associations with CSIs: diving, axial load, clotheslining, loss of consciousness, neck pain, inability to move neck, altered mental status, signs of basilar skull fracture, torso injury, thoracic injury, intubation, respiratory distress, decreased oxygen saturation, and neurologic deficits. The retrospective model (high-risk motor vehicle crash, diving, predisposing condition, neck pain, decreased neck mobility (report or exam), altered mental status, neurologic deficits, or torso injury) was 90.5{\%} (95{\%} confidence interval: 83.9{\%}–97.2{\%}) sensitive and 45.6{\%} (44.0{\%}–47.1{\%}) specific for CSIs. The de novo model (diving, axial load, neck pain, inability to move neck, altered mental status, intubation, or respiratory distress) was 92.0{\%} (85.7{\%}–98.1{\%}) sensitive and 50.3{\%} (48.7{\%}–51.8{\%}) specific. CONCLUSIONS: Our findings support previously identified pediatric CSI risk factors and prospective pediatric CSI prediction rule development.",
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N2 - BACKGROUND: Adult prediction rules for cervical spine injury (CSI) exist; however, pediatric rules do not. Our objectives were to determine test accuracies of retrospectively identified CSI risk factors in a prospective pediatric cohort and compare them to a de novo risk model. METHODS: We conducted a 4-center, prospective observational study of children 0 to 17 years old who experienced blunt trauma and underwent emergency medical services scene response, trauma evaluation, and/or cervical imaging. Emergency department providers recorded CSI risk factors. CSIs were classified by reviewing imaging, consultations, and/or telephone follow-up. We calculated bivariable relative risks, multivariable odds ratios, and test characteristics for the retrospective risk model and a de novo model. RESULTS: Of 4091 enrolled children, 74 (1.8%) had CSIs. Fourteen factors had bivariable associations with CSIs: diving, axial load, clotheslining, loss of consciousness, neck pain, inability to move neck, altered mental status, signs of basilar skull fracture, torso injury, thoracic injury, intubation, respiratory distress, decreased oxygen saturation, and neurologic deficits. The retrospective model (high-risk motor vehicle crash, diving, predisposing condition, neck pain, decreased neck mobility (report or exam), altered mental status, neurologic deficits, or torso injury) was 90.5% (95% confidence interval: 83.9%–97.2%) sensitive and 45.6% (44.0%–47.1%) specific for CSIs. The de novo model (diving, axial load, neck pain, inability to move neck, altered mental status, intubation, or respiratory distress) was 92.0% (85.7%–98.1%) sensitive and 50.3% (48.7%–51.8%) specific. CONCLUSIONS: Our findings support previously identified pediatric CSI risk factors and prospective pediatric CSI prediction rule development.

AB - BACKGROUND: Adult prediction rules for cervical spine injury (CSI) exist; however, pediatric rules do not. Our objectives were to determine test accuracies of retrospectively identified CSI risk factors in a prospective pediatric cohort and compare them to a de novo risk model. METHODS: We conducted a 4-center, prospective observational study of children 0 to 17 years old who experienced blunt trauma and underwent emergency medical services scene response, trauma evaluation, and/or cervical imaging. Emergency department providers recorded CSI risk factors. CSIs were classified by reviewing imaging, consultations, and/or telephone follow-up. We calculated bivariable relative risks, multivariable odds ratios, and test characteristics for the retrospective risk model and a de novo model. RESULTS: Of 4091 enrolled children, 74 (1.8%) had CSIs. Fourteen factors had bivariable associations with CSIs: diving, axial load, clotheslining, loss of consciousness, neck pain, inability to move neck, altered mental status, signs of basilar skull fracture, torso injury, thoracic injury, intubation, respiratory distress, decreased oxygen saturation, and neurologic deficits. The retrospective model (high-risk motor vehicle crash, diving, predisposing condition, neck pain, decreased neck mobility (report or exam), altered mental status, neurologic deficits, or torso injury) was 90.5% (95% confidence interval: 83.9%–97.2%) sensitive and 45.6% (44.0%–47.1%) specific for CSIs. The de novo model (diving, axial load, neck pain, inability to move neck, altered mental status, intubation, or respiratory distress) was 92.0% (85.7%–98.1%) sensitive and 50.3% (48.7%–51.8%) specific. CONCLUSIONS: Our findings support previously identified pediatric CSI risk factors and prospective pediatric CSI prediction rule development.

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