Clinical decision rules in cervical spine injury: A prospective study in a paediatric trauma centre

Abstract

Background: Paediatric cervical spine injury (CSI) is rare but can have devastating consequences. In an attempt to identify all children with CSI, many children are assessed for possible injury and may either be “clinically cleared” or receive imaging to exclude radiologically apparent injury. Clinical decision rules (CDRs), or proposed rules, are commonly used to guide imaging decisions despite limited evidence for their use in paediatric populations. Objectives: To determine the frequency of previously identified risk factors for CSI in children presenting to a single Queensland centre, and to assess the performance of commonly used CDRs or proposed rules when strictly applied to our population. Method: Prospective observational study of all children under 16 years presenting to the Emergency Department(ED) with possible CSI as defined either immobilization for possible CSI, neck pain the context of trauma or otherwise considered at risk by the ED team. Those with imaging prior to arrival were excluded. Results: 973 children were included. Median age was 10.9 years; two thirds were male.40.7% received imaging of their cervical spine; 5 children had CSI. While all three CDRs identified the children with CSI (Sens 100%, CI95 56-100), specificity was poor, ranging between 43 and 56%. Conclusion: Paediatric CSI is rare, and many children are clinically cleared without imaging. The use of current CDRs could, if strictly applied, result in more children receiving imaging than currently do. Research with a larger cohort is required to assess whether a more refined CDR can be designed to limit discomfort, cost and radiation exposure.L6273926882019-05-14 <br />