Interobserver Agreement in Pediatric Cervical Spine Injury Assessment Between Prehospital and Emergency Department Providers

Abstract

Emergency medical services and ED providers achieved at least moderate agreement in the assessment of CSI risk factors in children after blunt trauma. However, EMS and ED providers did not achieve moderate agreement on gestalt for CSI and some risk factors went unassessed by providers. These findings support the development of a pediatric CSI risk assessment tool for EMS and ED providers to reduce interventions for those children at very low risk for CSIs while still identifying all children with injury.

Cervical Spine Evaluation in Pediatric Trauma: A Review and an Update of Current Concepts

“… 13 14 Literature reports that around 11%-61.9% of CSIs occur secondary to motor vehicle accidents (MVA). 6 7 9 14 15 Birth-associated injuries are uniquely associated with infants. 16 17 Aggressive delivery techniques and breech presentations are significantly associated with CSIs.…”

“… 6 9 In older, school-going children, sports-related injuries are common (overall incidence reportedly varying between 11.3% and 49%). 6 15 18 19 20 Large case series involving children with inflicted injuries (or child abuse) report around 5.6% -13% incidence of CSIs in such scenarios. 4 7 21 22 …”

“…In a study by Browne et al . (2017) 15 only 16%-24% of children with CSI were classified by ED or EMS providers as under high suspicion category (>50% risk) for CSI based on symptomatology and initial presentation. In a retrospective review of 72 patients by Baker et al ., all asymptomatic CSI patients had both high-risk mechanism and distracting mode of injuries.…”

Pediatric Cervical Spine Injuries and SCIWORA: WFNS Spine Committee Recommendations

“…Blunt trauma is one of the most common reasons (95%) for cervical spine trauma, frequently due to motor vehicle incidents. 1,13,17,[20][21][22][23] CSIs due to falls were 9 percent higher in children aged less than 8 years in comparison to children aged over 8 years old. On the other hand, CSIs due to sports were more frequent in children over 8-year-old.…”

Incidence of Pediatric Cervical Spine Injuries in Iraq and Afghanistan

“…6,13,14 Universal consensus as to whether cervical spine immobilization in the pediatric population is beneficial or detrimental following a trauma is lacking. 11,15,16 No data exist describing the incidence of pediatric cervical spine injuries during combat operations in Iraq and Afghanistan. We sought to describe the incidence of pediatric cervical spine injuries during combat operations in Iraq and Afghanistan with the anticipation that it will reflect the low incidence of the civilian population.…”