Each Weekend We Cover a Landmark Article - On the Shoulders of Giants
It's no NEXUS
This was a retrospective trauma registry study, with all the limitations that go along with that. It found 4 variables that correlated with c-spine injury in children with blunt trauma under 3 years. They made a weighted score for these variables.
- GCS < 14 = 3 points
- GCS eye score 1 = 2 points
- MVC = 2 points
- Age 2 or older (bearing in mind, they included only kids <3 years) = 1 point
Over 12,500 patients were included; 0.66% (83 kids) had c-spine injury. Such a low prevalence meant 99.3% were without disease, making it hard to improve on the negative predictive value. But they did, slightly. In a validation cohort, those with a score <2 (meaning a score of 0 or 1), had negative predictive value 99.93; sensitivity 92.9%; specificity 69.9%.
This is far from a prospective, internally and externally validated clinical decision rule, so be cautious using this in practice. But children with trauma under age 3 with altered mental status, low GCS eye component, or possibly MVC mechanism warrant consideration of c-spine imaging.
C-spine injury is rare in children under 3 years. GCS < 14, GCS (eye) of 1, MVC mechanism, or age between 2- 3 years were associated with c-spine injury. BestBets has an excellent review of this and 3 other papers on this topic.
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. J Trauma. 2009 Sep;67(3):543-9; discussion 549-50. doi: 10.1097/TA.0b013e3181b57aa1.