Pediatr Emerg Med J.  2023 Apr;10(2):60-67. 10.22470/pemj.2022.00577.

Current status of imaging studies and application of clinical decision rules for pediatric blunt cervical spine injury

• Ko KH
• Lee HJ
• Kim HJ
• Shin TY
• Lee DW
• Moon HJ
• Jeong DK

• KMID: 2540910
• DOI: http://doi.org/10.22470/pemj.2022.00577

Abstract

Purpose
We investigated the current status of imaging studies for pediatric blunt cervical spine injury, and applied 3 clinical decision rules to children with blunt trauma of the head or neck in a pediatric emergency center in Korea. The rules included National Emergency X-Radiography Utilization Study (NEXUS) criteria, Canadian Cervical Spine Rule, and Pediatric Emergency Care Applied Research Network risk factors.
Methods
This was a retrospective study conducted on 399 children aged 15 years or younger who visited the center after the blunt trauma, and underwent cervical spine radiographs from January 2020 through December 2021. We examined the clinical characteristics per age groups (0-1, 2-5, 6-12, and 13-15 years). Using the 3 rules, we selected children with a potential need for imaging studies (PNI). For this purpose, we analyzed the absence of low-risk variables and the presence of high-risk variables. Predictive performances of the rules were measured for the imaging-confirmed cervical spine injury.
Results
The study population (n = 399) had a median age of 5.0 years (interquartile range, 2.0-9.0) and a 64.2% boys’ proportion. Fall (36.6%) was the most common injury mechanism. Two children had the cervical spine injuries. As per NEXUS criteria, Canadian Cervical Spine Rule, and Pediatric Emergency Care Applied Research Network risk factors, 72 (18.0%), 289 (72.4%), and 74 children (18.5%) were classified as those with PNI, respectively. Resultantly, 291 children (72.9%) were classified as having PNI whereas the other 108 (27.1%) were deemed to undergo unnecessary imaging. The 3 rules had nearly 100% sensitivity and negative predictive value, except a 50% sensitivity of NEXUS criteria.
Conclusion
Imaging studies can be minimized for children with blunt trauma of the head or neck who are deemed without PNI per the 3 current clinical decision rules. More elaborate criteria are needed to make a timely diagnosis.

Keyword

Cervical Vertebrae; Clinical Decision Rules; Neck Pain; Pediatrics; Spinal Cord Injuries

Figure

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  Fig. 1. Flowchart for the selection of study population. EMR: electronic medical record.

Reference

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