title: The sensitivity and negative predictive value of a pediatric cervical spine clearance algorithm that minimizes computerized tomography.
abstract: BACKGROUND
  It is crucial to identify cervical spine injuries while minimizing ionizing radiation. This study analyzes the sensitivity and negative predictive value of a pediatric cervical spine clearance algorithm.
  
  
  METHODS
  We performed a retrospective review of all children <21years old who were admitted following blunt trauma and underwent cervical spine clearance utilizing our institution's cervical spine clearance algorithm over a 10-year period. Age, gender, International Classification of Diseases 9th Edition diagnosis codes, presence or absence of cervical collar on arrival, Injury Severity Score, and type of cervical spine imaging obtained were extracted from the trauma registry and electronic medical record. Descriptive statistics were used and the sensitivity and negative predictive value of the algorithm were calculated.
  
  
  RESULTS
  Approximately 125,000 children were evaluated in the Emergency Department and 11,331 were admitted. Of the admitted children, 1023 patients arrived in a cervical collar without advanced cervical spine imaging and were evaluated using the cervical spine clearance algorithm. Algorithm sensitivity was 94.4% and the negative predictive value was 99.9%. There was one missed injury, a spinous process tip fracture in a teenager maintained in a collar.
  
  
  CONCLUSIONS
  Our algorithm was associated with a low missed injury rate and low CT utilization rate, even in children <3years old.
  
  
  METHODS
  IV.
authors.affiliation: Boston Children's Hospital, Department of Surgery, Harvard Medical School, 300 Longwood Ave, Fegan 3, Boston, MA 02115. Electronic address: mary.kathleen.arbuthnot@gmail.com.
authors.forename: Mary
authors.initials: M
authors.lastname: Arbuthnot
authors.affiliation: Boston Children's Hospital, Department of Surgery, Harvard Medical School, 300 Longwood Ave, Fegan 3, Boston, MA 02115. Electronic address: david.mooney@childrens.harvard.edu.
authors.forename: David P
authors.initials: DP
authors.lastname: Mooney
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D019838:Neck Injuries / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*
keywords: Algorithm; Cervical spine; Ct; Pediatric; Radiation; Trauma