title: Subaxial injury classification scoring system treatment recommendations: external agreement study based on retrospective review of 185 patients.
abstract: METHODS
  Retrospective case series.
  
  
  OBJECTIVE
  To test validity of subaxial injury classification (SLIC) treatment recommendations.
  
  
  BACKGROUND
  Although SLIC has been tested for reliability, external studies that test the validity of its treatment recommendations are lacking.
  
  
  METHODS
  The SLIC score was determined by reviewing imaging studies and clinical records in a consecutive series of 185 patients with subaxial cervical spine trauma presenting to a level 1 spinal injury referral center. Details including attending surgeon responsible for treatment decision, treatment received, and surgical approach were collected.
  
  
  RESULTS
  Treatment received matched SLIC guidelines in 93.6% nonsurgically managed patients and 96.3% surgically managed patients. The mean SLIC score of the surgically treated group of patients was significantly higher than that of the nonsurgical group (7.14 vs. 2.22; P<0.001). Sixty-six patients had a SLIC score of 3 or less, and 94% of them were nonsurgically managed (P<0.001). One hundred two patients had a SLIC score of 5 or more, and 95% of them were surgically managed (P<0.001). Seventeen patients had a SLIC score of 4, and 65% were nonsurgically managed (P=0.032). Injury morphology scores were not predictive of surgical approach. Increasing SLIC scores correlated with increasing complexity of treatment (r=0.77; P<0.001). The distribution of patients with regard to severity of injuries and treatment delivered by the 7 spinal surgeons was comparable. The past practice of these 7 fellowship-trained spine surgeons was individually in agreement with SLIC treatment recommendations.
  
  
  CONCLUSIONS
  Our past practice reflects SLIC treatment recommendations for nonsurgical treatment of patients with SLIC scores of 3 or less and surgical treatment of patients with SLIC scores of 5 or more. The use of SLIC as an ordinal severity scale is validated as increasing SLIC scores correlated with increasing complexity of treatment. The injury morphology score did not predict a surgical approach. Significantly higher numbers of patients with a SLIC score of 4 were treated nonsurgically.
  
  
  METHODS
  3.
authors.affiliation: From the Department of Orthopaedic and Traumatic Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia.
authors.forename: Sumant
authors.initials: S
authors.lastname: Samuel
authors.forename: Jiun-Lih
authors.initials: JL
authors.lastname: Lin
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Smith
authors.forename: Nathan L
authors.initials: NL
authors.lastname: Hartin
authors.forename: Con
authors.initials: C
authors.lastname: Vasili
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Ruff
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Cree
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Ball
authors.forename: Ioannis G
authors.initials: IG
authors.lastname: Sergides
authors.forename: Randolph
authors.initials: R
authors.lastname: Gray
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000175:diagnosis* / Q000601:surgery; D055815:Young Adult