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 Stankovic, Getachew Teshome, David M Jaffe
Annals of Emergency Medicine 2011, 58 (2): 145-55

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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