A. S. Chaudhry1, S. Bloom1, J. McGinn1, C. Fasanya1, J. Schulz1, M. Price1 1North Shore University And Long Island Jewish Medical Center,Staten Island University Hospital/ Surgery,Manhasset, NY, USA
Cervical spine injuries (CSI) are rare in children. A vast majority is related to blunt trauma, occurring in less than 1% of those evaluated. So far, there is no established standardized protocol in the pediatric population to clear the cervical spine. Exposing children to harmful radiations due to excessive CT scan runs a risk of malignancy, that is 25% higher in the exposed group. The Canadian C-Spine rule and National Emergency X-Radiography Utilization Study (NEXUS) criteria for adults are more than 99% sensitive for identifying cervical spine injuries in adults. The purpose of this study is to evaluate certain risk stratification strategies for identification of cervical spine injury (CSI) in pediatric trauma patients.
Methods
With IRB approval we retrospectively reviewed the records of Pediatric Trauma Registries from two state designated level 1 pediatric trauma centers for 11 years (January 2002 and June 2013),inclusive. Patients age 1 month to 17 years who had a CT of the C-spine and evaluated for Cervical Spine Injury (CSI). We identified variables associated with increasing incidence of CSI in the literature and evaluated all patients as per these variables. The Age, Gender, Injury severity score (ISS), Glasgow coma score (GCS), LOC (Loss of consciousness), neck tenderness, significant injuries, and mechanism of injuries were examined for differences based on the presence or absence of cervical spine Injuries (CSI).
Results
A total of 220 cases were reviewed 46 (21%) were positive for CSI and 174(79%) were negative for CSI. Patients with a positive CSI were male (p=0.0261) had ISS > 25 (p=0.00076) and presented with neck tenderness (p=0.0001). The most common mechanism of injury was motor vehicle crashes (39%). LOC unexpectadly was not associated with having CSI (p=0.0003). Upper CSI (C1-C4) were more prevalent inyounger age group (0-8yrs) i.e (82.35%), while lower CSI (C5-C8) were more common in older children (9-16yrs) i.e (44.83%). However this result was not statistically significant (p=0.0617). There was statistically no significant association between CSI and Age, GCS, other significant injuries, or mechanism of injury.
Conclusion:
In our study significant CSI is related to male gender, higher ISS and neck tenderness. Patients with significant ISS and those with neck tenderness require diagnostic imaging appropriate for patients who have a higher likelihood of CSI. We propose a protocol for cervical spine injury clearance in children based on this data. Those patients who do not need the above criteria may be saved from undergoing excessive CT scans, in an effort to lower children radiation exposuretion:
