title: Multicenter retrospective evaluation of the validity of the Thoracolumbar Injury Classification and Severity Score system in children.
abstract: OBJECTIVE The Thoracolumbar Injury Classification and Severity Score (TLICS) system was developed to streamline injury assessment and guide surgical decision making. To the best of the authors' knowledge, external validation in the pediatric age group has not been undertaken prior to this report. METHODS This study evaluated the use of the TLICS in a large retrospective series of children and adolescents treated at 4 pediatric medical centers (Texas Children's Hospital, Children's Healthcare of Atlanta, Riley Children's Hospital, and Doernbecher Children's Hospital). A total of 147 patients treated for traumatic thoracic or lumbar spine trauma between February 1, 2002, and September 1, 2015, were included in this study. Clinical and radiographic data were evaluated. Injuries were classified using American Spinal Injury Association (ASIA) status, Denis classification, and TLICS. RESULTS A total of 102 patients (69%) were treated conservatively, and 45 patients (31%) were treated surgically. All patients but one in the conservative group were classified as ASIA E. In this group, 86/102 patients (84%) had Denis type compression injuries. The TLICS in the conservative group ranged from 1 to 10 (mean 1.6). Overall, 93% of patients matched TLICS conservative treatment recommendations (score ≤ 3). No patients crossed over to the surgical group in delayed fashion. In the surgical group, 26/45 (58%) were ASIA E, whereas 19/45 (42%) had neurological deficits (ASIA A, B, C, or D). One of 45 (2%) patients was classified with Denis type compression injuries; 25/45 (56%) were classified with Denis type burst injuries; 14/45 (31%) were classified with Denis type seat belt injuries; and 5/45 (11%) were classified with Denis type fracture-dislocation injuries. The TLICS ranged from 2 to 10 (mean 6.4). Eighty-two percent of patients matched TLICS surgical treatment recommendations (score ≥ 5). No patients crossed over to the conservative management group. Eight patients (8/147, 5%) had a calculated TLICS of 4, which meant they were candidates for surgery or conservative therapy by TLICS criteria. Excluding these patients, the degree of agreement between TLICS and surgeon decision was deemed to be very good (κ = 0.878). CONCLUSIONS The TLICS results and recommendations matched treatment in 96% of conservative group cases. In the surgical group, TLICS recommendations matched treatment in 93% of cases. The TLICS recommendations and surgeon decision making displayed very good concordance. The TLICS appears to be effective in the classification of thoracic and lumbar spine injuries and in guiding treatment in the pediatric age group.
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Sellin
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;
authors.forename: William J
authors.initials: WJ
authors.lastname: Steele
authors.affiliation: Division of Pediatric Neurosurgery, Doernbecher Children's Hospital, Portland, Oregon.
authors.forename: Lauren
authors.initials: L
authors.lastname: Simpson
authors.affiliation: Division of Pediatric Neurosurgery, Riley Children's Hospital, Indianapolis, Indiana; and.
authors.forename: Wei X
authors.initials: WX
authors.lastname: Huff
authors.affiliation: Division of Pediatric Neurosurgery, Riley Children's Hospital, Indianapolis, Indiana; and.
authors.forename: Brandon C
authors.initials: BC
authors.lastname: Lane
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurosurgery, Emory University, Atlanta, Georgia;
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Chern
authors.affiliation: Division of Pediatric Neurosurgery, Riley Children's Hospital, Indianapolis, Indiana; and.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Fulkerson
authors.affiliation: Division of Pediatric Neurosurgery, Doernbecher Children's Hospital, Portland, Oregon.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Sayama
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;
authors.forename: Andrew
authors.initials: A
authors.lastname: Jea
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000145:classification* / Q000175:diagnosis*; D013904:Thoracic Vertebrae / Q000293:injuries*
keywords: ASIA = American Spinal Injury Association; MVA = motor vehicle accident; PLC = posterior ligamentous complex; SCIWORA = Spinal Cord Injury Without Radiographic Abnormality; TLICS; TLICS = Thoracolumbar Injury Classification and Severity Score; Thoracolumbar Injury Classification and Severity Score system; children; pediatric spine; spine trauma