Pediatric cervical spine clearance: a 10-year evaluation of X-ray in evaluable patients at a level 1 pediatric trauma center
Objectives Cervical spine (c-spine) X-ray (XR) remains an important tool for pediatric trauma patients. XR is a low radiation alternative to multidetector CT (MDCT). Our primary aims were to analyze the sensitivity of a negative c-spine XR and to analyze what factors lead to additional imaging after...
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| Language: | English |
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BMJ Publishing Group
2025-08-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/10/3/e001539.full |
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| author | Jing Wang William Starr Stephanie Iantorno Richard Eldredge Rajiv Iyer Karch Smith Natalya McNamara Kezlyn Larsen Stephen Fenton Robert Swendiman Katie Russell |
| author_facet | Jing Wang William Starr Stephanie Iantorno Richard Eldredge Rajiv Iyer Karch Smith Natalya McNamara Kezlyn Larsen Stephen Fenton Robert Swendiman Katie Russell |
| author_sort | Jing Wang |
| collection | DOAJ |
| description | Objectives Cervical spine (c-spine) X-ray (XR) remains an important tool for pediatric trauma patients. XR is a low radiation alternative to multidetector CT (MDCT). Our primary aims were to analyze the sensitivity of a negative c-spine XR and to analyze what factors lead to additional imaging after a negative c-spine XR.Methods A retrospective cohort study was conducted at a level 1 pediatric trauma center from 2012 to 2021. We compared the group with negative c-spine XR and no additional imaging to the group with negative c-spine XR followed by additional c-spine MDCT and/or MRI.Results There were 2,081 negative XRs and 1,974 (95%) had their c-spines cleared without additional imaging. No patient required an operation for a clinically significant c-spine injury in this group, and we consider this no missed injuries. The remaining 108 patients had additional c-spine imaging after negative c-spine XR for c-spine clearance (24 MDCT, 76 MRI, 8 MDCT and MRI). Indications for additional c-spine imaging were pain (48.1%), Glasgow Coma Scale (GCS) score ≤14 (43.5%), and paresthesia (8.3%). Patients who received additional imaging were more likely to have a GCS score ≤12 (25.4% vs 4.1%), Injury Severity Score >15 (21.9% vs 8.1%), Level 1 Trauma activation (21% vs 5%), Abbreviated Injury Scale head score of 4 or 5 (29% vs 5%), be intubated (30% vs 2%), and have non-accidental trauma as their mechanism of injury (20% vs 1%) (p value<0.0001, for all). Five patients who received additional imaging were treated with a cervical collar, but no operative intervention.Conclusions In this cohort, screening XR had a sensitivity of 100% for clinically significant c-spine injuries. GCS was the most significant predictor of obtaining additional imaging. A negative XR combined with a normal physical examination in an evaluable pediatric patient is a safe way of clearing the c-spine.Level of evidence Study contains level III evidence. |
| format | Article |
| id | doaj-art-a238cbc50a5448e1b2a7b488ead78046 |
| institution | DOAJ |
| issn | 2397-5776 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-a238cbc50a5448e1b2a7b488ead780462025-08-20T02:53:29ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762025-08-0110310.1136/tsaco-2024-001539Pediatric cervical spine clearance: a 10-year evaluation of X-ray in evaluable patients at a level 1 pediatric trauma centerJing Wang0William Starr1Stephanie Iantorno2Richard Eldredge3Rajiv Iyer4Karch Smith5Natalya McNamara6Kezlyn Larsen7Stephen Fenton8Robert Swendiman9Katie Russell10Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USADepartment of Surgery, University of Utah Health, Salt Lake City, Utah, USADepartment of Surgery, University of Utah Health, Salt Lake City, Utah, USAMayo Clinic Arizona, Scottsdale, Arizona, USADepartment of Neurosurgery, University of Utah Health, Salt Lake City, Utah, USADepartment of Surgery, University of Utah Health, Salt Lake City, Utah, USADepartment of Surgery, University of Utah Health, Salt Lake City, Utah, USADepartment of Surgery, University of Utah Health, Salt Lake City, Utah, USADepartment of Surgery, University of Utah Health, Salt Lake City, Utah, USADepartment of Surgery, University of Utah Health, Salt Lake City, Utah, USADepartment of Surgery, University of Utah Health, Salt Lake City, Utah, USAObjectives Cervical spine (c-spine) X-ray (XR) remains an important tool for pediatric trauma patients. XR is a low radiation alternative to multidetector CT (MDCT). Our primary aims were to analyze the sensitivity of a negative c-spine XR and to analyze what factors lead to additional imaging after a negative c-spine XR.Methods A retrospective cohort study was conducted at a level 1 pediatric trauma center from 2012 to 2021. We compared the group with negative c-spine XR and no additional imaging to the group with negative c-spine XR followed by additional c-spine MDCT and/or MRI.Results There were 2,081 negative XRs and 1,974 (95%) had their c-spines cleared without additional imaging. No patient required an operation for a clinically significant c-spine injury in this group, and we consider this no missed injuries. The remaining 108 patients had additional c-spine imaging after negative c-spine XR for c-spine clearance (24 MDCT, 76 MRI, 8 MDCT and MRI). Indications for additional c-spine imaging were pain (48.1%), Glasgow Coma Scale (GCS) score ≤14 (43.5%), and paresthesia (8.3%). Patients who received additional imaging were more likely to have a GCS score ≤12 (25.4% vs 4.1%), Injury Severity Score >15 (21.9% vs 8.1%), Level 1 Trauma activation (21% vs 5%), Abbreviated Injury Scale head score of 4 or 5 (29% vs 5%), be intubated (30% vs 2%), and have non-accidental trauma as their mechanism of injury (20% vs 1%) (p value<0.0001, for all). Five patients who received additional imaging were treated with a cervical collar, but no operative intervention.Conclusions In this cohort, screening XR had a sensitivity of 100% for clinically significant c-spine injuries. GCS was the most significant predictor of obtaining additional imaging. A negative XR combined with a normal physical examination in an evaluable pediatric patient is a safe way of clearing the c-spine.Level of evidence Study contains level III evidence.https://tsaco.bmj.com/content/10/3/e001539.full |
| spellingShingle | Jing Wang William Starr Stephanie Iantorno Richard Eldredge Rajiv Iyer Karch Smith Natalya McNamara Kezlyn Larsen Stephen Fenton Robert Swendiman Katie Russell Pediatric cervical spine clearance: a 10-year evaluation of X-ray in evaluable patients at a level 1 pediatric trauma center Trauma Surgery & Acute Care Open |
| title | Pediatric cervical spine clearance: a 10-year evaluation of X-ray in evaluable patients at a level 1 pediatric trauma center |
| title_full | Pediatric cervical spine clearance: a 10-year evaluation of X-ray in evaluable patients at a level 1 pediatric trauma center |
| title_fullStr | Pediatric cervical spine clearance: a 10-year evaluation of X-ray in evaluable patients at a level 1 pediatric trauma center |
| title_full_unstemmed | Pediatric cervical spine clearance: a 10-year evaluation of X-ray in evaluable patients at a level 1 pediatric trauma center |
| title_short | Pediatric cervical spine clearance: a 10-year evaluation of X-ray in evaluable patients at a level 1 pediatric trauma center |
| title_sort | pediatric cervical spine clearance a 10 year evaluation of x ray in evaluable patients at a level 1 pediatric trauma center |
| url | https://tsaco.bmj.com/content/10/3/e001539.full |
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