Clinical Clearance of the Cervical Spine in Blunt Trauma Patients Younger Than 3 Years: A Multi-Center Study of the American Association for the Surgery of Trauma
BACKGROUND:Cervical spine clearance in the very young child is challenging. Radiographic imaging to diagnose cervical spine injuries (CSI) even in the absence of clinical findings is common, raising concerns about radiation exposure and imaging-related complications. We examined whether simple clini...
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| Veröffentlicht in: | The Journal of trauma, injury, infection, and critical care injury, infection, and critical care, 2009-09, Vol.67 (3), p.543-550 |
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| creator | Pieretti-Vanmarcke, Rafael Velmahos, George C. Nance, Michael L. Islam, Saleem Falcone, Richard A. Wales, Paul W. Brown, Rebeccah L. Gaines, Barbara A. McKenna, Christine Moore, Forrest O. Goslar, Pamela W. Inaba, Kenji Barmparas, Galinos Scaife, Eric R. Metzger, Ryan R. Brockmeyer, Douglas L. Upperman, Jeffrey S. Estrada, Joaquin Lanning, David A. Rasmussen, Sara K. Danielson, Paul D. Hirsh, Michael P. Consani, Heitor F. X. Stylianos, Steven Pineda, Candace Norwood, Scott H. Bruch, Steven W. Drongowski, Robert Barraco, Robert D. Pasquale, Michael D. Hussain, Farheen Hirsch, Erwin F. McNeely, P Daniel Fallat, Mary E. Foley, David S. Iocono, Joseph A. Bennett, Heather M. Waxman, Kenneth Kam, Kelly Bakhos, Lisa Petrovick, Laurie Chang, Yuchiao Masiakos, Peter T. |
| description | BACKGROUND:Cervical spine clearance in the very young child is challenging. Radiographic imaging to diagnose cervical spine injuries (CSI) even in the absence of clinical findings is common, raising concerns about radiation exposure and imaging-related complications. We examined whether simple clinical criteria can be used to safely rule out CSI in patients younger than 3 years.
METHODS:The trauma registries from 22 level I or II trauma centers were reviewed for the 10-year period (January 1995 to January 2005). Blunt trauma patients younger than 3 years were identified. The measured outcome was CSI. Independent predictors of CSI were identified by univariate and multivariate analysis. A weighted score was calculated by assigning 1, 2, or 3 points to each independent predictor according to its magnitude of effect. The score was established on two thirds of the population and validated using the remaining one third.
RESULTS:Of 12,537 patients younger than 3 years, CSI was identified in 83 patients (0.66%), eight had spinal cord injury. Four independent predictors of CSI were identifiedGlasgow Coma Score |
| doi_str_mv | 10.1097/TA.0b013e3181b57aa1 |
| format | Article |
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METHODS:The trauma registries from 22 level I or II trauma centers were reviewed for the 10-year period (January 1995 to January 2005). Blunt trauma patients younger than 3 years were identified. The measured outcome was CSI. Independent predictors of CSI were identified by univariate and multivariate analysis. A weighted score was calculated by assigning 1, 2, or 3 points to each independent predictor according to its magnitude of effect. The score was established on two thirds of the population and validated using the remaining one third.
RESULTS:Of 12,537 patients younger than 3 years, CSI was identified in 83 patients (0.66%), eight had spinal cord injury. Four independent predictors of CSI were identifiedGlasgow Coma Score <14, GCSEYE = 1, motor vehicle crash, and age 2 years or older. A score of <2 had a negative predictive value of 99.93% in ruling out CSI. A total of 8,707 patients (69.5% of all patients) had a score of <2 and were eligible for cervical spine clearance without imaging. There were no missed CSI in this study.
CONCLUSIONS:CSI in patients younger than 3 years is uncommon. Four simple clinical predictors can be used in conjunction to the physical examination to substantially reduce the use of radiographic imaging in this patient population.</description><identifier>ISSN: 0022-5282</identifier><identifier>EISSN: 1529-8809</identifier><identifier>DOI: 10.1097/TA.0b013e3181b57aa1</identifier><identifier>PMID: 19741398</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins, Inc</publisher><subject>Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cervical Vertebrae - injuries ; Child, Preschool ; Cohort Studies ; Diseases of the osteoarticular system ; Female ; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation ; Humans ; Infant ; Injuries of the limb. Injuries of the spine ; Magnetic Resonance Imaging ; Male ; Medical sciences ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; Spinal Injuries - diagnosis ; Spinal Injuries - epidemiology ; Tomography, X-Ray Computed ; Trauma Severity Indices ; Traumas. Diseases due to physical agents ; United States ; Wounds, Nonpenetrating - complications ; Wounds, Nonpenetrating - diagnosis</subject><ispartof>The Journal of trauma, injury, infection, and critical care, 2009-09, Vol.67 (3), p.543-550</ispartof><rights>2009 Lippincott Williams & Wilkins, Inc.</rights><rights>2009 INIST-CNRS</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4489-34943b64f8818426dbb4fd6213bdfb0471a81c9997722706e7d09cbe39c27b623</citedby><cites>FETCH-LOGICAL-c4489-34943b64f8818426dbb4fd6213bdfb0471a81c9997722706e7d09cbe39c27b623</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>309,310,314,776,780,785,786,23909,23910,25118,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21933130$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19741398$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pieretti-Vanmarcke, Rafael</creatorcontrib><creatorcontrib>Velmahos, George C.</creatorcontrib><creatorcontrib>Nance, Michael L.</creatorcontrib><creatorcontrib>Islam, Saleem</creatorcontrib><creatorcontrib>Falcone, Richard A.</creatorcontrib><creatorcontrib>Wales, Paul W.</creatorcontrib><creatorcontrib>Brown, Rebeccah L.</creatorcontrib><creatorcontrib>Gaines, Barbara A.</creatorcontrib><creatorcontrib>McKenna, Christine</creatorcontrib><creatorcontrib>Moore, Forrest O.</creatorcontrib><creatorcontrib>Goslar, Pamela W.</creatorcontrib><creatorcontrib>Inaba, Kenji</creatorcontrib><creatorcontrib>Barmparas, Galinos</creatorcontrib><creatorcontrib>Scaife, Eric R.</creatorcontrib><creatorcontrib>Metzger, Ryan R.</creatorcontrib><creatorcontrib>Brockmeyer, Douglas L.</creatorcontrib><creatorcontrib>Upperman, Jeffrey S.</creatorcontrib><creatorcontrib>Estrada, Joaquin</creatorcontrib><creatorcontrib>Lanning, David A.</creatorcontrib><creatorcontrib>Rasmussen, Sara K.</creatorcontrib><creatorcontrib>Danielson, Paul D.</creatorcontrib><creatorcontrib>Hirsh, Michael P.</creatorcontrib><creatorcontrib>Consani, Heitor F. X.</creatorcontrib><creatorcontrib>Stylianos, Steven</creatorcontrib><creatorcontrib>Pineda, Candace</creatorcontrib><creatorcontrib>Norwood, Scott H.</creatorcontrib><creatorcontrib>Bruch, Steven W.</creatorcontrib><creatorcontrib>Drongowski, Robert</creatorcontrib><creatorcontrib>Barraco, Robert D.</creatorcontrib><creatorcontrib>Pasquale, Michael D.</creatorcontrib><creatorcontrib>Hussain, Farheen</creatorcontrib><creatorcontrib>Hirsch, Erwin F.</creatorcontrib><creatorcontrib>McNeely, P Daniel</creatorcontrib><creatorcontrib>Fallat, Mary E.</creatorcontrib><creatorcontrib>Foley, David S.</creatorcontrib><creatorcontrib>Iocono, Joseph A.</creatorcontrib><creatorcontrib>Bennett, Heather M.</creatorcontrib><creatorcontrib>Waxman, Kenneth</creatorcontrib><creatorcontrib>Kam, Kelly</creatorcontrib><creatorcontrib>Bakhos, Lisa</creatorcontrib><creatorcontrib>Petrovick, Laurie</creatorcontrib><creatorcontrib>Chang, Yuchiao</creatorcontrib><creatorcontrib>Masiakos, Peter T.</creatorcontrib><title>Clinical Clearance of the Cervical Spine in Blunt Trauma Patients Younger Than 3 Years: A Multi-Center Study of the American Association for the Surgery of Trauma</title><title>The Journal of trauma, injury, infection, and critical care</title><addtitle>J Trauma</addtitle><description>BACKGROUND:Cervical spine clearance in the very young child is challenging. Radiographic imaging to diagnose cervical spine injuries (CSI) even in the absence of clinical findings is common, raising concerns about radiation exposure and imaging-related complications. We examined whether simple clinical criteria can be used to safely rule out CSI in patients younger than 3 years.
METHODS:The trauma registries from 22 level I or II trauma centers were reviewed for the 10-year period (January 1995 to January 2005). Blunt trauma patients younger than 3 years were identified. The measured outcome was CSI. Independent predictors of CSI were identified by univariate and multivariate analysis. A weighted score was calculated by assigning 1, 2, or 3 points to each independent predictor according to its magnitude of effect. The score was established on two thirds of the population and validated using the remaining one third.
RESULTS:Of 12,537 patients younger than 3 years, CSI was identified in 83 patients (0.66%), eight had spinal cord injury. Four independent predictors of CSI were identifiedGlasgow Coma Score <14, GCSEYE = 1, motor vehicle crash, and age 2 years or older. A score of <2 had a negative predictive value of 99.93% in ruling out CSI. A total of 8,707 patients (69.5% of all patients) had a score of <2 and were eligible for cervical spine clearance without imaging. There were no missed CSI in this study.
CONCLUSIONS:CSI in patients younger than 3 years is uncommon. Four simple clinical predictors can be used in conjunction to the physical examination to substantially reduce the use of radiographic imaging in this patient population.</description><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Cervical Vertebrae - injuries</subject><subject>Child, Preschool</subject><subject>Cohort Studies</subject><subject>Diseases of the osteoarticular system</subject><subject>Female</subject><subject>General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation</subject><subject>Humans</subject><subject>Infant</subject><subject>Injuries of the limb. Injuries of the spine</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Predictive Value of Tests</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Spinal Injuries - diagnosis</subject><subject>Spinal Injuries - epidemiology</subject><subject>Tomography, X-Ray Computed</subject><subject>Trauma Severity Indices</subject><subject>Traumas. Diseases due to physical agents</subject><subject>United States</subject><subject>Wounds, Nonpenetrating - complications</subject><subject>Wounds, Nonpenetrating - diagnosis</subject><issn>0022-5282</issn><issn>1529-8809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkc1u1DAURi0EotPCEyAhb2CXcv2T2GYXIihIRSBNWHQV2YnDBBxnsGOqvg5PijszgIQsy4vv3GPpfgg9I3BJQIlXbX0JBgizjEhiSqE1eYA2pKSqkBLUQ7QBoLQoqaRn6DzGbwDAOZOP0RlRghOm5Ab9atzkp1473Dirg_a9xcuI153FjQ0_D8l2P3mLJ4_fuORX3AadZo0_63Wyfo34Zkn-qw243WmPGb7Jmvga1_hjcutUNJnJ4XZNw90fcz3bkM0e1zEu_ZRFi8fjEg7hNoVsO7DHn56gR6N20T49vRfoy7u3bfO-uP509aGpr4uec6kKxhVnpuKjlERyWg3G8HGoKGFmGA1wQbQkvVJKCEoFVFYMoHpjmeqpMBVlF-jl0bsPy49k49rNU-ytc9rbJcWuEhVXZcUzyI5gH5YYgx27fZhmHe46At19NV1bd_9Xk6een_TJzHb4N3PqIgMvToCOee3jfRlT_MtRohgjDDLHj9zt4vJq43eXbm3odla7ddflkqFkghUUQOUDUOSbZ38DIZGnnQ</recordid><startdate>200909</startdate><enddate>200909</enddate><creator>Pieretti-Vanmarcke, Rafael</creator><creator>Velmahos, George C.</creator><creator>Nance, Michael L.</creator><creator>Islam, Saleem</creator><creator>Falcone, Richard A.</creator><creator>Wales, Paul W.</creator><creator>Brown, Rebeccah L.</creator><creator>Gaines, Barbara A.</creator><creator>McKenna, Christine</creator><creator>Moore, Forrest O.</creator><creator>Goslar, Pamela W.</creator><creator>Inaba, Kenji</creator><creator>Barmparas, Galinos</creator><creator>Scaife, Eric R.</creator><creator>Metzger, Ryan R.</creator><creator>Brockmeyer, Douglas L.</creator><creator>Upperman, Jeffrey S.</creator><creator>Estrada, Joaquin</creator><creator>Lanning, David A.</creator><creator>Rasmussen, Sara K.</creator><creator>Danielson, Paul D.</creator><creator>Hirsh, Michael P.</creator><creator>Consani, Heitor F. X.</creator><creator>Stylianos, Steven</creator><creator>Pineda, Candace</creator><creator>Norwood, Scott H.</creator><creator>Bruch, Steven W.</creator><creator>Drongowski, Robert</creator><creator>Barraco, Robert D.</creator><creator>Pasquale, Michael D.</creator><creator>Hussain, Farheen</creator><creator>Hirsch, Erwin F.</creator><creator>McNeely, P Daniel</creator><creator>Fallat, Mary E.</creator><creator>Foley, David S.</creator><creator>Iocono, Joseph A.</creator><creator>Bennett, Heather M.</creator><creator>Waxman, Kenneth</creator><creator>Kam, Kelly</creator><creator>Bakhos, Lisa</creator><creator>Petrovick, Laurie</creator><creator>Chang, Yuchiao</creator><creator>Masiakos, Peter T.</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200909</creationdate><title>Clinical Clearance of the Cervical Spine in Blunt Trauma Patients Younger Than 3 Years: A Multi-Center Study of the American Association for the Surgery of Trauma</title><author>Pieretti-Vanmarcke, Rafael ; Velmahos, George C. ; Nance, Michael L. ; Islam, Saleem ; Falcone, Richard A. ; Wales, Paul W. ; Brown, Rebeccah L. ; Gaines, Barbara A. ; McKenna, Christine ; Moore, Forrest O. ; Goslar, Pamela W. ; Inaba, Kenji ; Barmparas, Galinos ; Scaife, Eric R. ; Metzger, Ryan R. ; Brockmeyer, Douglas L. ; Upperman, Jeffrey S. ; Estrada, Joaquin ; Lanning, David A. ; Rasmussen, Sara K. ; Danielson, Paul D. ; Hirsh, Michael P. ; Consani, Heitor F. X. ; Stylianos, Steven ; Pineda, Candace ; Norwood, Scott H. ; Bruch, Steven W. ; Drongowski, Robert ; Barraco, Robert D. ; Pasquale, Michael D. ; Hussain, Farheen ; Hirsch, Erwin F. ; McNeely, P Daniel ; Fallat, Mary E. ; Foley, David S. ; Iocono, Joseph A. ; Bennett, Heather M. ; Waxman, Kenneth ; Kam, Kelly ; Bakhos, Lisa ; Petrovick, Laurie ; Chang, Yuchiao ; Masiakos, Peter T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4489-34943b64f8818426dbb4fd6213bdfb0471a81c9997722706e7d09cbe39c27b623</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Anesthesia</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Cervical Vertebrae - injuries</topic><topic>Child, Preschool</topic><topic>Cohort Studies</topic><topic>Diseases of the osteoarticular system</topic><topic>Female</topic><topic>General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation</topic><topic>Humans</topic><topic>Infant</topic><topic>Injuries of the limb. Injuries of the spine</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Predictive Value of Tests</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Spinal Injuries - diagnosis</topic><topic>Spinal Injuries - epidemiology</topic><topic>Tomography, X-Ray Computed</topic><topic>Trauma Severity Indices</topic><topic>Traumas. Diseases due to physical agents</topic><topic>United States</topic><topic>Wounds, Nonpenetrating - complications</topic><topic>Wounds, Nonpenetrating - diagnosis</topic><toplevel>online_resources</toplevel><creatorcontrib>Pieretti-Vanmarcke, Rafael</creatorcontrib><creatorcontrib>Velmahos, George C.</creatorcontrib><creatorcontrib>Nance, Michael L.</creatorcontrib><creatorcontrib>Islam, Saleem</creatorcontrib><creatorcontrib>Falcone, Richard A.</creatorcontrib><creatorcontrib>Wales, Paul W.</creatorcontrib><creatorcontrib>Brown, Rebeccah L.</creatorcontrib><creatorcontrib>Gaines, Barbara A.</creatorcontrib><creatorcontrib>McKenna, Christine</creatorcontrib><creatorcontrib>Moore, Forrest O.</creatorcontrib><creatorcontrib>Goslar, Pamela W.</creatorcontrib><creatorcontrib>Inaba, Kenji</creatorcontrib><creatorcontrib>Barmparas, Galinos</creatorcontrib><creatorcontrib>Scaife, Eric R.</creatorcontrib><creatorcontrib>Metzger, Ryan R.</creatorcontrib><creatorcontrib>Brockmeyer, Douglas L.</creatorcontrib><creatorcontrib>Upperman, Jeffrey S.</creatorcontrib><creatorcontrib>Estrada, Joaquin</creatorcontrib><creatorcontrib>Lanning, David A.</creatorcontrib><creatorcontrib>Rasmussen, Sara K.</creatorcontrib><creatorcontrib>Danielson, Paul D.</creatorcontrib><creatorcontrib>Hirsh, Michael P.</creatorcontrib><creatorcontrib>Consani, Heitor F. X.</creatorcontrib><creatorcontrib>Stylianos, Steven</creatorcontrib><creatorcontrib>Pineda, Candace</creatorcontrib><creatorcontrib>Norwood, Scott H.</creatorcontrib><creatorcontrib>Bruch, Steven W.</creatorcontrib><creatorcontrib>Drongowski, Robert</creatorcontrib><creatorcontrib>Barraco, Robert D.</creatorcontrib><creatorcontrib>Pasquale, Michael D.</creatorcontrib><creatorcontrib>Hussain, Farheen</creatorcontrib><creatorcontrib>Hirsch, Erwin F.</creatorcontrib><creatorcontrib>McNeely, P Daniel</creatorcontrib><creatorcontrib>Fallat, Mary E.</creatorcontrib><creatorcontrib>Foley, David S.</creatorcontrib><creatorcontrib>Iocono, Joseph A.</creatorcontrib><creatorcontrib>Bennett, Heather M.</creatorcontrib><creatorcontrib>Waxman, Kenneth</creatorcontrib><creatorcontrib>Kam, Kelly</creatorcontrib><creatorcontrib>Bakhos, Lisa</creatorcontrib><creatorcontrib>Petrovick, Laurie</creatorcontrib><creatorcontrib>Chang, Yuchiao</creatorcontrib><creatorcontrib>Masiakos, Peter T.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of trauma, injury, infection, and critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pieretti-Vanmarcke, Rafael</au><au>Velmahos, George C.</au><au>Nance, Michael L.</au><au>Islam, Saleem</au><au>Falcone, Richard A.</au><au>Wales, Paul W.</au><au>Brown, Rebeccah L.</au><au>Gaines, Barbara A.</au><au>McKenna, Christine</au><au>Moore, Forrest O.</au><au>Goslar, Pamela W.</au><au>Inaba, Kenji</au><au>Barmparas, Galinos</au><au>Scaife, Eric R.</au><au>Metzger, Ryan R.</au><au>Brockmeyer, Douglas L.</au><au>Upperman, Jeffrey S.</au><au>Estrada, Joaquin</au><au>Lanning, David A.</au><au>Rasmussen, Sara K.</au><au>Danielson, Paul D.</au><au>Hirsh, Michael P.</au><au>Consani, Heitor F. X.</au><au>Stylianos, Steven</au><au>Pineda, Candace</au><au>Norwood, Scott H.</au><au>Bruch, Steven W.</au><au>Drongowski, Robert</au><au>Barraco, Robert D.</au><au>Pasquale, Michael D.</au><au>Hussain, Farheen</au><au>Hirsch, Erwin F.</au><au>McNeely, P Daniel</au><au>Fallat, Mary E.</au><au>Foley, David S.</au><au>Iocono, Joseph A.</au><au>Bennett, Heather M.</au><au>Waxman, Kenneth</au><au>Kam, Kelly</au><au>Bakhos, Lisa</au><au>Petrovick, Laurie</au><au>Chang, Yuchiao</au><au>Masiakos, Peter T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical Clearance of the Cervical Spine in Blunt Trauma Patients Younger Than 3 Years: A Multi-Center Study of the American Association for the Surgery of Trauma</atitle><jtitle>The Journal of trauma, injury, infection, and critical care</jtitle><addtitle>J Trauma</addtitle><date>2009-09</date><risdate>2009</risdate><volume>67</volume><issue>3</issue><spage>543</spage><epage>550</epage><pages>543-550</pages><issn>0022-5282</issn><eissn>1529-8809</eissn><abstract>BACKGROUND:Cervical spine clearance in the very young child is challenging. Radiographic imaging to diagnose cervical spine injuries (CSI) even in the absence of clinical findings is common, raising concerns about radiation exposure and imaging-related complications. We examined whether simple clinical criteria can be used to safely rule out CSI in patients younger than 3 years.
METHODS:The trauma registries from 22 level I or II trauma centers were reviewed for the 10-year period (January 1995 to January 2005). Blunt trauma patients younger than 3 years were identified. The measured outcome was CSI. Independent predictors of CSI were identified by univariate and multivariate analysis. A weighted score was calculated by assigning 1, 2, or 3 points to each independent predictor according to its magnitude of effect. The score was established on two thirds of the population and validated using the remaining one third.
RESULTS:Of 12,537 patients younger than 3 years, CSI was identified in 83 patients (0.66%), eight had spinal cord injury. Four independent predictors of CSI were identifiedGlasgow Coma Score <14, GCSEYE = 1, motor vehicle crash, and age 2 years or older. A score of <2 had a negative predictive value of 99.93% in ruling out CSI. A total of 8,707 patients (69.5% of all patients) had a score of <2 and were eligible for cervical spine clearance without imaging. There were no missed CSI in this study.
CONCLUSIONS:CSI in patients younger than 3 years is uncommon. Four simple clinical predictors can be used in conjunction to the physical examination to substantially reduce the use of radiographic imaging in this patient population.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>19741398</pmid><doi>10.1097/TA.0b013e3181b57aa1</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0022-5282 |
| ispartof | The Journal of trauma, injury, infection, and critical care, 2009-09, Vol.67 (3), p.543-550 |
| issn | 0022-5282 1529-8809 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_67649564 |
| source | MEDLINE; Journals@Ovid Complete |
| subjects | Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cervical Vertebrae - injuries Child, Preschool Cohort Studies Diseases of the osteoarticular system Female General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation Humans Infant Injuries of the limb. Injuries of the spine Magnetic Resonance Imaging Male Medical sciences Predictive Value of Tests Retrospective Studies Risk Factors Spinal Injuries - diagnosis Spinal Injuries - epidemiology Tomography, X-Ray Computed Trauma Severity Indices Traumas. Diseases due to physical agents United States Wounds, Nonpenetrating - complications Wounds, Nonpenetrating - diagnosis |
| title | Clinical Clearance of the Cervical Spine in Blunt Trauma Patients Younger Than 3 Years: A Multi-Center Study of the American Association for the Surgery of Trauma |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-01T08%3A55%3A04IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Clinical%20Clearance%20of%20the%20Cervical%20Spine%20in%20Blunt%20Trauma%20Patients%20Younger%20Than%203%20Years:%20A%20Multi-Center%20Study%20of%20the%20American%20Association%20for%20the%20Surgery%20of%20Trauma&rft.jtitle=The%20Journal%20of%20trauma,%20injury,%20infection,%20and%20critical%20care&rft.au=Pieretti-Vanmarcke,%20Rafael&rft.date=2009-09&rft.volume=67&rft.issue=3&rft.spage=543&rft.epage=550&rft.pages=543-550&rft.issn=0022-5282&rft.eissn=1529-8809&rft_id=info:doi/10.1097/TA.0b013e3181b57aa1&rft_dat=%3Cproquest_cross%3E67649564%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=67649564&rft_id=info:pmid/19741398&rfr_iscdi=true |