Jason Vargas, MD
Children's Hospital of Nevada at UMC
Northridge, California
Disclosure information not submitted.
Christopher Babbitt, MD
Pediatric Intensivist
MemorialCare Miller Childrens Hospital and Womens Hospital Long Beach
Long Beach, California
Disclosure information not submitted.
Philip Suh, MD
Fellow
Miller Children's and Women's Hospital, United States
Disclosure information not submitted.
Dennys Estevez
Senior Statistician
Lundquist Institute, United States
Disclosure information not submitted.
Brant Putnam, MD
Attending
University of California Los Angeles/Harbor Medical Center, United States
Disclosure information not submitted.
Elizabeth Benjamin, MD
Attending
Los Angeles County-USC Medical Center, United States
Disclosure information not submitted.
Richard Mink, MD, MACM,FCCM
Director, Pediatric Critical Care Fellowship
Harbor UCLA Medical Center, United States
Disclosure information not submitted.
Title: A Clinical Decision Tool to Predict the Need for Cervical Imaging in Children Less Than 8 Years
INTRODUCTION/HYPOTHESIS: Pediatric cervical spine injury (CSI) occurs in 1-2% of pediatric blunt traumas. If unrecognized, there is significant risk of neurologic disability. Identification of CSI based solely on history in infants and children is problematic as cognitive development limits the reliability of the exam. We previously identified 6 risk factors that increased the odds of having a CSI in children < 8 years. The objective of this study was to determine the probability of not having a CSI in the absence of these risk factors in children < 8 years who sustained trauma.
Methods: This is a reanalysis of study data in which 6 risk factors for having a CSI after trauma were identified (cervical spine tenderness, motor vehicle injury, loss of consciousness (LOC), distracting injury, displaced skull fracture, and ventricular hemorrhage). Data were obtained from children < 8 years with traumatic injury admitted to 1 of 3 level 1 pediatric trauma centers between August 2007 and August 2017. CSI was defined as 1) radiographic evidence of CSI, or 2) radiographic evidence of CSI and/or treatment due to clinical concern. Negative predictive values (NPV) were calculated, first including the absence of all 6 risk factors and then including fewer.
Results: Of 5187 patients evaluated, 80(1.7%) had a CSI based upon radiography and 111(2.1%) based on clinical concern. 1045 patients did not have any of the 6 risk factors and only 1(0.10%) had a CSI by radiography and 4(0.38%) by clinical concern. Not including the absence of neck tenderness in the model had little effect on the NPV. However, when only absence of motor vehicle injury, LOC, displaced fracture and ventricular hemorrhage remained in the model, the probability of CSI by radiography (6/2212 (0.27%) or clinical concern (10/2208 (0.45%) increased. Use of only absence of LOC was a poor negative predictor of CSI (radiography: 40/4290 (0.92%); clinical concern: 61/4269 (1.41%)).
Conclusion: Children < 8 years who sustain trauma not from motor vehicle injury and have no LOC, displaced skull fracture, distracting injury or ventricular hemorrhage are at very low risk of a CSI. The absence of neck tenderness has little effect on the NPV. These data suggest that children who do not have these risk factors may not need radiographic imaging of their cervical spine