The Sensitivity and Negative Predictive Value of a Pediatric Cervical Spine Clearance Algorithm that Minimizes Computerized Tomography

• Published in: Journal of pediatric surgery Vol. 52; no. 1; pp. 130 - 135
• Main Authors: Arbuthnot, Mary, Mooney, David
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2017
• Subjects: Adolescent; Algorithm; Algorithms; Cervical spine; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - injuries; Child; Child, Preschool; Emergency Service, Hospital; Female; Humans; Injury Severity Score; Male; Neck Injuries - diagnostic imaging; Pediatric; Pediatrics; Predictive Value of Tests; Radiation; Registries; Retrospective Studies; Sensitivity and Specificity; Surgery; Tomography, X-Ray Computed; Trauma; Wounds, Nonpenetrating - diagnostic imaging; CT; cervical spine; radiation; Trauma; algorithm; pediatric; Ct; Algorithm; Pediatric; Cervical spine; Radiation
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2016.10.031

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 < 21 years 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,1,023 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 < 3 years old. Level of Evidence IV