The clinical presentation of pediatric thoracolumbar fractures: a prospective study.
BACKGROUND
Thoracolumbar spine (TLS) fractures are rare in the pediatric population but may result in significant morbidity, necessitating a prompt diagnosis. No formal recommendations have been made for screening pediatric trauma patients for TLS fractures; early diagnosis has traditionally relied on clinical parameters extrapolated from adult data.


METHODS
From March 2004 to April 2005 patients presenting to a level one pediatric trauma center were consecutively enrolled. Clinicians were asked to assess eligible patients and prospectively state their TLS examination findings and degree of clinical suspicion for fracture.


RESULTS
A total of 228 patients were enrolled (mean age of 8.2 years), 16 with TLS fractures. Clinical performance of the TLS spine examination diagnosed a fracture with a sensitivity of 81% (95% CI: 0.57, 0.93), specificity of 68% (0.62, 0.74), and odds ratio of 9.38 (2.59, 34.01). A clinician's degree of suspicion detected a TLS fracture with a sensitivity of 56% (95% CI: 0.33, 0.77), specificity of 82% (0.77, 0.87), and odds ratio of 6.08 (2.13, 17.37).


CONCLUSIONS
The clinician is able to clinically diagnose TLS fractures in pediatric trauma patients with good sensitivity and average specificity, however, TLS fractures were missed. Screening radiographs may still be required until larger studies confirm these findings.
Junkins
Edward P
EP
Division of Pediatric Emergency Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA. Ed.junkins@hsc.utah.edu
Stotts
Alan
A
Santiago
Rafael
R
Guenther
Elisabeth
E
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D011446:Prospective Studies; D016103:Spinal Fractures / Q000175:diagnosis*; D013904:Thoracic Vertebrae / Q000293:injuries*; D014949:Wounds, Nonpenetrating