Clinical clearance of the cervical spine in blunt trauma patients younger than 3 years: a multi-center study of the american association for the surgery of trauma.
BACKGROUND
Cervical spine clearance in the very young child is challenging. Radiographic imaging to diagnose cervical spine injuries (CSI) even in the absence of clinical findings is common, raising concerns about radiation exposure and imaging-related complications. We examined whether simple clinical criteria can be used to safely rule out CSI in patients younger than 3 years.


METHODS
The trauma registries from 22 level I or II trauma centers were reviewed for the 10-year period (January 1995 to January 2005). Blunt trauma patients younger than 3 years were identified. The measured outcome was CSI. Independent predictors of CSI were identified by univariate and multivariate analysis. A weighted score was calculated by assigning 1, 2, or 3 points to each independent predictor according to its magnitude of effect. The score was established on two thirds of the population and validated using the remaining one third.


RESULTS
Of 12,537 patients younger than 3 years, CSI was identified in 83 patients (0.66%), eight had spinal cord injury. Four independent predictors of CSI were identified: Glasgow Coma Score <14, GCSEYE = 1, motor vehicle crash, and age 2 years or older. A score of <2 had a negative predictive value of 99.93% in ruling out CSI. A total of 8,707 patients (69.5% of all patients) had a score of <2 and were eligible for cervical spine clearance without imaging. There were no missed CSI in this study.


CONCLUSIONS
CSI in patients younger than 3 years is uncommon. Four simple clinical predictors can be used in conjunction to the physical examination to substantially reduce the use of radiographic imaging in this patient population.
Pieretti-Vanmarcke
Rafael
R
Department of Pediatric Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Velmahos
George C
GC
Nance
Michael L
ML
Islam
Saleem
S
Falcone
Richard A
RA
Wales
Paul W
PW
Brown
Rebeccah L
RL
Gaines
Barbara A
BA
McKenna
Christine
C
Moore
Forrest O
FO
Goslar
Pamela W
PW
Inaba
Kenji
K
Barmparas
Galinos
G
Scaife
Eric R
ER
Metzger
Ryan R
RR
Brockmeyer
Douglas L
DL
Upperman
Jeffrey S
JS
Estrada
Joaquin
J
Lanning
David A
DA
Rasmussen
Sara K
SK
Danielson
Paul D
PD
Hirsh
Michael P
MP
Consani
Heitor F X
HF
Stylianos
Steven
S
Pineda
Candace
C
Norwood
Scott H
SH
Bruch
Steven W
SW
Drongowski
Robert
R
Barraco
Robert D
RD
Pasquale
Michael D
MD
Hussain
Farheen
F
Hirsch
Erwin F
EF
McNeely
P Daniel
PD
Fallat
Mary E
ME
Foley
David S
DS
Iocono
Joseph A
JA
Bennett
Heather M
HM
Waxman
Kenneth
K
Kam
Kelly
K
Bakhos
Lisa
L
Petrovick
Laurie
L
Chang
Yuchiao
Y
Masiakos
Peter T
PT
D002574:Cervical Vertebrae / Q000293:injuries*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013124:Spinal Injuries / Q000175:diagnosis* / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D014481:United States; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis*