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Predicting Cervical Spine Injury in Children
Rudy Kink, MD1, Wes Rainbolt, MD1, Kate B Savoie, MD, MS2, Amy Wise, BS1, John Matthew Williams, MS1, Regan F Williams, MD1,2. 1Department of Pediatrics, University of Tennessee Health Science Center, Memphis,TN, USA, 2Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.

Background: The current trend in pediatric trauma is to minimize radiation exposure from imaging; c-spine injuries remain difficult to diagnose without computed tomography(CT). We sought to identify predictors for cervical spine injuries to determine which pediatric patients would benefit from a CT of the cervical spine for further evaluation.

Methods: All pediatric patients <17 years who presented to a tertiary freestanding pediatric level 1 trauma center over 4 years that had a cervical spine CT performed for trauma were reviewed. Univariate and bivariate analysis were performed and a multivariable model was used to identify predictors of cervical spine injury.

Results: Overall 590 patients were identified with 99 patients diagnosed with a cervical spine injury. Though age and sex were not associated with injury, it was associated with caucasion race. MVC was the most common mechanism of action(42%) followed by sports related injuries(16%). No patients with a cervical spine injury suffered an assault. In a multivariable analysis race, neck pain, a neurologic deficit, altered mental status, emergency department intubation and transfer status were found to be significant predictors of cervical spine injury.

Conclusions: Cervical spine injury was associated with white race, intubation, transfer from another facility, neurologic deficit and neck pain on initial exam consistent with the NEXUS criteria. Awake children who present from assault without clinical signs of injury have low risk of injury and may not benefit from CT of the cervical spine.

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