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

Abstract

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.

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

“…The eight factors identified in our parent study are supported by numerous smaller studies that identified high-risk MVC, as well as neurologic and neck physical examination findings, as being associated with CSIs in children. [2][3][4][5] Furthermore, the current study's findings reinforce the sensitivity of the original model in that applying age-stratified models did not improve the ability to detect CSI in the three separate age cohorts, particularly in children younger than 2 years old.…”

“…The benefit of age-stratified models for CSI, particularly for the very young, is also supported by the findings of other investigators. 5,9 In a retrospective, multicenter trauma registry review of children younger than 3 years old, four factors demonstrated 100% sensitivity and 70% specificity for CSI: age 2 up to 3 years, Glasgow Coma Scale (GCS) score of <14, GCS eye opening score of 1, and MVC injury mechanism. A recent single-center retrospective review of young children with spine injury supports these findings.…”

“…1 Prior large, prospective investigations and primary source reviews aimed at developing risk stratification strategies for CSI evaluation to restrict potentially harmful interventions have been limited by few children with CSIs, especially children younger than 8 years. [1][2][3][4][5] Inclusion of young children in studies of CSI is important, as children are exposed to different mechanisms of injury throughout childhood and undergo developmental anatomical changes that influence CSI patterns. 5,6 The Pediatric Emergency Care Applied Research Network (PECARN; Participating Centers and Investigators 3 are listed in Appendix A) CSI study was a large, multicenter, retrospective case-control study to identify risk factors for CSIs in children.…”

“…[1][2][3][4][5] Inclusion of young children in studies of CSI is important, as children are exposed to different mechanisms of injury throughout childhood and undergo developmental anatomical changes that influence CSI patterns. 5,6 The Pediatric Emergency Care Applied Research Network (PECARN; Participating Centers and Investigators 3 are listed in Appendix A) CSI study was a large, multicenter, retrospective case-control study to identify risk factors for CSIs in children. 2 In the primary analysis, we identified eight patient history and physical examination findings associated with CSIs in children: altered mental status, focal neurologic findings, complaint of neck pain, torticollis, substantial torso injury, predisposing conditions, diving, and high-risk motor vehicle crash (MVC).…”

Fractures of the axis: a review of pediatric, adult, and geriatric injuries

“…These This article is part of the Topical Collection on Cervical Injuries and Treatment facts emphasize the need for an organized method for evaluation of the upper cervical spine in the pediatric population. While several studies have attempted to provide a "perfect" decision algorithm, the consensus seems to be that application of the National Emergency XRadiography Utilization Study (NEXUS) to children older than 9 years old is appropriate, while any concerning sign or symptom in a younger child should elicit a radiographic evaluation of the cervical spine [4,6].…”