Age‐related Differences in Factors Associated With Cervical Spine Injuries in Children

Abstract

Objectives: The Pediatric Emergency Care Applied Research Network (PECARN) investigators previously identified risk factors associated with cervical spine injuries (CSIs) in children. Anatomic maturation and age-related variation in mechanisms of injury suggested the need to explore factors separately for younger versus older children. The purpose of this substudy was to investigate CSI risk factors in age subgroups within the PECARN study cohort.Methods: This was an age-stratified case-control analysis of children younger than 16 years presenting to 17 PECARN hospitals following blunt trauma between January 1, 2000 and December 31, 2004. Data were abstracted for children with CSIs and randomly selected CSI-free children. Age-stratified multivariable logistic regression was performed to identify factors associated with CSI within three age groups: younger than 2, 2 to 7, and 8 to 15 years. Sensitivity and specificity for CSI were estimated for both the age-specific and original (altered mental status, focal neurologic findings, neck pain, torticollis, substantial torso injury, predisposing conditions, diving, and high-risk motor vehicle crash [MVC]) models.Results: Among 540 children with CSIs, 27 were younger than 2 years, 140 were 2 to 7 years, and 373 were 8 to 15 years. Focal neurologic deficits and high-risk MVC were associated with CSIs in all agespecific models. Other age-specific factors included the following: younger than 2 years, none; 2 to 7 years, altered mental status, neck pain, torticollis; and 8 to 15 years, altered mental status, neck pain, diving. Age-specific models had comparable sensitivity to the original model among the older groups, but had lower sensitivity and higher specificity among the youngest children.Conclusions: While this analysis supports the original PECARN model for CSI, there were subtle age variations in factors associated with CSIs in children that warrant future investigation.ACADEMIC EMERGENCY MEDICINE 2015;22:441-446

Pediatric Cervical Spine Clearance and Immobilization Practice Among Prehospital Emergency Medical Providers

“…Younger children tend to have greater higher-level C-spine injuries, fewer fractures, more dislocations, and more spinal cord injury without radiological abnormalities because of their larger head-to-body ratio, greater ligament laxity, and horizontal facet joints. [13][14][15][16] Outcomes are often poorer in younger than in older children, including persistent neurological deficits and higher mortality. 13,14 More recently, investigators from the Pediatric Emergency Care Applied Research Network (PECARN) have used pediatric trauma data from multiple institutions to identify C-spine injury risk factors in children with blunt trauma.…”

“…15 In a follow-up study using age stratification in the PECARN study cohort, presence of focal neurological deficits and high-risk motor vehicular crashes were shown to be risk factors for C-spine injuries in all ages. 16 Browne et al 17 analyzed interobserver agreement in pediatric CSI risk assessment between EMS and emergency department providers. The investigators found that interobserver agreement was at least "moderate" in assessment of the 8 risk factors identified by PECARN study group after blunt trauma 15,16 ; however, some risk factors were unassessed, such as neck pain, inability to move the neck, and cervical spine tenderness.…”

“…16 Browne et al 17 analyzed interobserver agreement in pediatric CSI risk assessment between EMS and emergency department providers. The investigators found that interobserver agreement was at least "moderate" in assessment of the 8 risk factors identified by PECARN study group after blunt trauma 15,16 ; however, some risk factors were unassessed, such as neck pain, inability to move the neck, and cervical spine tenderness. Additionally, the agreement on overall gestalt for CSI in children between EMS and emergency department providers was less than moderate.…”

Current status of imaging studies and application of clinical decision rules for pediatric blunt cervical spine injury

“…NEXUS 기준의 민감도 및 특이도는 각각 99.6% 및 12.9%, CCR은 각각 100% 및 42.5%으로 알려졌다 5,6) . 하지만 소아환자는 성인과 손상 기전 및 해부학적 구조 면에서 차이가 있으므로, 이 규칙을 소아에게 적용하기 적절치 않을 수 있다 12,13,[17][18][19][20][21] . 본 연구에서 경추손상 환자가 2명에 불과하여 평가하기 어렵지만, NEXUS 기준의 민감도가 CCR 및 PECARN 위험인자의 민감도보다 낮았다.…”

Cervical Spine Injury Risk Factors in Children With Blunt Trauma

“…The Pediatric Emergency Care Applied Research Network (PECARN) conducted a 17-center, 5-year, retrospective case-control study that identified risk factors associated with CSIs in children with blunt trauma (altered mental status, focal neurologic findings, neck pain, torticollis [decreased neck mobility by report or exam], substantial torso injury, conditions predisposing to CSI, diving, and high-risk motor vehicle crash [MVC]). 31,32 These factors were 98% sensitive for CSIs within the study cohort and, if used as a prediction rule, would reduce cohort imaging by at least 25%.…”