Factors associated with cervical spine injury in children after blunt trauma

Julie C. Leonard, Nathan Kuppermann, Cody Olsen, Lynn Babcock-Cimpello, Kathleen Brown, Prashant Mahajan, Kathleen M. Adelgais, Jennifer Anders, Dominic Borgialli, Aaron Donoghue, John D. Hoyle, Emily Kim, Jeffrey R. Leonard, Kathleen A. Lillis, Lise E. Nigrovic, Elizabeth C. Powell, Greg Rebella, Scott D. Reeves, Alexander J. Rogers, Curt StankovicGetachew Teshome, David M. Jaffe

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Study objective Cervical spine injuries in children are rare. However, immobilization and imaging for potential cervical spine injury after trauma are common and are associated with adverse effects. Risk factors for cervical spine injury have been developed to safely limit immobilization and radiography in adults, but not in children. The purpose of our study is to identify risk factors associated with cervical spine injury in children after blunt trauma. Methods We conducted a case-control study of children younger than 16 years, presenting after blunt trauma, and who received cervical spine radiographs at 17 hospitals in the Pediatric Emergency Care Applied Research Network (PECARN) between January 2000 and December 2004. Cases were children with cervical spine injury. We created 3 control groups of children free of cervical spine injury: (1) random controls, (2) age and mechanism of injury-matched controls, and (3) for cases receiving out-of-hospital emergency medical services (EMS), age-matched controls who also received EMS care. We abstracted data from 3 sources: PECARN hospital, referring hospital, and out-of-hospital patient records. We performed multiple logistic regression analyses to identify predictors of cervical spine injury and calculated the model's sensitivity and specificity. Results We reviewed 540 records of children with cervical spine injury and 1,060, 1,012, and 702 random, mechanism of injury, and EMS controls, respectively. In the analysis using random controls, we identified 8 factors associated with cervical spine injury: altered mental status, focal neurologic findings, neck pain, torticollis, substantial torso injury, conditions predisposing to cervical spine injury, diving, and high-risk motor vehicle crash. Having 1 or more factors was 98% (95% confidence interval 96% to 99%) sensitive and 26% (95% confidence interval 23% to 29%) specific for cervical spine injury. We identified similar risk factors in the other analyses. Conclusion We identified an 8-variable model for cervical spine injury in children after blunt trauma that warrants prospective refinement and validation.

Original languageEnglish (US)
Pages (from-to)145-155
Number of pages11
JournalAnnals of Emergency Medicine
Volume58
Issue number2
DOIs
StatePublished - Aug 2011

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Spine
Wounds and Injuries
Emergency Medical Services
Immobilization
Confidence Intervals
Torticollis
Torso
Diving
Pediatric Hospitals
Hospital Records
Neck Pain
Information Storage and Retrieval
Motor Vehicles
Neurologic Manifestations
Research
Radiography
Case-Control Studies
Hospital Emergency Service

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Leonard, J. C., Kuppermann, N., Olsen, C., Babcock-Cimpello, L., Brown, K., Mahajan, P., ... Jaffe, D. M. (2011). Factors associated with cervical spine injury in children after blunt trauma. Annals of Emergency Medicine, 58(2), 145-155. https://doi.org/10.1016/j.annemergmed.2010.08.038

Factors associated with cervical spine injury in children after blunt trauma. / Leonard, Julie C.; Kuppermann, Nathan; Olsen, Cody; Babcock-Cimpello, Lynn; Brown, Kathleen; Mahajan, Prashant; Adelgais, Kathleen M.; Anders, Jennifer; Borgialli, Dominic; Donoghue, Aaron; Hoyle, John D.; Kim, Emily; Leonard, Jeffrey R.; Lillis, Kathleen A.; Nigrovic, Lise E.; Powell, Elizabeth C.; Rebella, Greg; Reeves, Scott D.; Rogers, Alexander J.; Stankovic, Curt; Teshome, Getachew; Jaffe, David M.

In: Annals of Emergency Medicine, Vol. 58, No. 2, 08.2011, p. 145-155.

Research output: Contribution to journalArticle

Leonard, JC, Kuppermann, N, Olsen, C, Babcock-Cimpello, L, Brown, K, Mahajan, P, Adelgais, KM, Anders, J, Borgialli, D, Donoghue, A, Hoyle, JD, Kim, E, Leonard, JR, Lillis, KA, Nigrovic, LE, Powell, EC, Rebella, G, Reeves, SD, Rogers, AJ, Stankovic, C, Teshome, G & Jaffe, DM 2011, 'Factors associated with cervical spine injury in children after blunt trauma', Annals of Emergency Medicine, vol. 58, no. 2, pp. 145-155. https://doi.org/10.1016/j.annemergmed.2010.08.038
Leonard, Julie C. ; Kuppermann, Nathan ; Olsen, Cody ; Babcock-Cimpello, Lynn ; Brown, Kathleen ; Mahajan, Prashant ; Adelgais, Kathleen M. ; Anders, Jennifer ; Borgialli, Dominic ; Donoghue, Aaron ; Hoyle, John D. ; Kim, Emily ; Leonard, Jeffrey R. ; Lillis, Kathleen A. ; Nigrovic, Lise E. ; Powell, Elizabeth C. ; Rebella, Greg ; Reeves, Scott D. ; Rogers, Alexander J. ; Stankovic, Curt ; Teshome, Getachew ; Jaffe, David M. / Factors associated with cervical spine injury in children after blunt trauma. In: Annals of Emergency Medicine. 2011 ; Vol. 58, No. 2. pp. 145-155.
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abstract = "Study objective Cervical spine injuries in children are rare. However, immobilization and imaging for potential cervical spine injury after trauma are common and are associated with adverse effects. Risk factors for cervical spine injury have been developed to safely limit immobilization and radiography in adults, but not in children. The purpose of our study is to identify risk factors associated with cervical spine injury in children after blunt trauma. Methods We conducted a case-control study of children younger than 16 years, presenting after blunt trauma, and who received cervical spine radiographs at 17 hospitals in the Pediatric Emergency Care Applied Research Network (PECARN) between January 2000 and December 2004. Cases were children with cervical spine injury. We created 3 control groups of children free of cervical spine injury: (1) random controls, (2) age and mechanism of injury-matched controls, and (3) for cases receiving out-of-hospital emergency medical services (EMS), age-matched controls who also received EMS care. We abstracted data from 3 sources: PECARN hospital, referring hospital, and out-of-hospital patient records. We performed multiple logistic regression analyses to identify predictors of cervical spine injury and calculated the model's sensitivity and specificity. Results We reviewed 540 records of children with cervical spine injury and 1,060, 1,012, and 702 random, mechanism of injury, and EMS controls, respectively. In the analysis using random controls, we identified 8 factors associated with cervical spine injury: altered mental status, focal neurologic findings, neck pain, torticollis, substantial torso injury, conditions predisposing to cervical spine injury, diving, and high-risk motor vehicle crash. Having 1 or more factors was 98{\%} (95{\%} confidence interval 96{\%} to 99{\%}) sensitive and 26{\%} (95{\%} confidence interval 23{\%} to 29{\%}) specific for cervical spine injury. We identified similar risk factors in the other analyses. Conclusion We identified an 8-variable model for cervical spine injury in children after blunt trauma that warrants prospective refinement and validation.",
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T1 - Factors associated with cervical spine injury in children after blunt trauma

AU - Leonard, Julie C.

AU - Kuppermann, Nathan

AU - Olsen, Cody

AU - Babcock-Cimpello, Lynn

AU - Brown, Kathleen

AU - Mahajan, Prashant

AU - Adelgais, Kathleen M.

AU - Anders, Jennifer

AU - Borgialli, Dominic

AU - Donoghue, Aaron

AU - Hoyle, John D.

AU - Kim, Emily

AU - Leonard, Jeffrey R.

AU - Lillis, Kathleen A.

AU - Nigrovic, Lise E.

AU - Powell, Elizabeth C.

AU - Rebella, Greg

AU - Reeves, Scott D.

AU - Rogers, Alexander J.

AU - Stankovic, Curt

AU - Teshome, Getachew

AU - Jaffe, David M.

PY - 2011/8

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N2 - Study objective Cervical spine injuries in children are rare. However, immobilization and imaging for potential cervical spine injury after trauma are common and are associated with adverse effects. Risk factors for cervical spine injury have been developed to safely limit immobilization and radiography in adults, but not in children. The purpose of our study is to identify risk factors associated with cervical spine injury in children after blunt trauma. Methods We conducted a case-control study of children younger than 16 years, presenting after blunt trauma, and who received cervical spine radiographs at 17 hospitals in the Pediatric Emergency Care Applied Research Network (PECARN) between January 2000 and December 2004. Cases were children with cervical spine injury. We created 3 control groups of children free of cervical spine injury: (1) random controls, (2) age and mechanism of injury-matched controls, and (3) for cases receiving out-of-hospital emergency medical services (EMS), age-matched controls who also received EMS care. We abstracted data from 3 sources: PECARN hospital, referring hospital, and out-of-hospital patient records. We performed multiple logistic regression analyses to identify predictors of cervical spine injury and calculated the model's sensitivity and specificity. Results We reviewed 540 records of children with cervical spine injury and 1,060, 1,012, and 702 random, mechanism of injury, and EMS controls, respectively. In the analysis using random controls, we identified 8 factors associated with cervical spine injury: altered mental status, focal neurologic findings, neck pain, torticollis, substantial torso injury, conditions predisposing to cervical spine injury, diving, and high-risk motor vehicle crash. Having 1 or more factors was 98% (95% confidence interval 96% to 99%) sensitive and 26% (95% confidence interval 23% to 29%) specific for cervical spine injury. We identified similar risk factors in the other analyses. Conclusion We identified an 8-variable model for cervical spine injury in children after blunt trauma that warrants prospective refinement and validation.

AB - Study objective Cervical spine injuries in children are rare. However, immobilization and imaging for potential cervical spine injury after trauma are common and are associated with adverse effects. Risk factors for cervical spine injury have been developed to safely limit immobilization and radiography in adults, but not in children. The purpose of our study is to identify risk factors associated with cervical spine injury in children after blunt trauma. Methods We conducted a case-control study of children younger than 16 years, presenting after blunt trauma, and who received cervical spine radiographs at 17 hospitals in the Pediatric Emergency Care Applied Research Network (PECARN) between January 2000 and December 2004. Cases were children with cervical spine injury. We created 3 control groups of children free of cervical spine injury: (1) random controls, (2) age and mechanism of injury-matched controls, and (3) for cases receiving out-of-hospital emergency medical services (EMS), age-matched controls who also received EMS care. We abstracted data from 3 sources: PECARN hospital, referring hospital, and out-of-hospital patient records. We performed multiple logistic regression analyses to identify predictors of cervical spine injury and calculated the model's sensitivity and specificity. Results We reviewed 540 records of children with cervical spine injury and 1,060, 1,012, and 702 random, mechanism of injury, and EMS controls, respectively. In the analysis using random controls, we identified 8 factors associated with cervical spine injury: altered mental status, focal neurologic findings, neck pain, torticollis, substantial torso injury, conditions predisposing to cervical spine injury, diving, and high-risk motor vehicle crash. Having 1 or more factors was 98% (95% confidence interval 96% to 99%) sensitive and 26% (95% confidence interval 23% to 29%) specific for cervical spine injury. We identified similar risk factors in the other analyses. Conclusion We identified an 8-variable model for cervical spine injury in children after blunt trauma that warrants prospective refinement and validation.

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