Rana Ankur R, Drongowski Robert, Breckner Gretchen, Ehrlich Peter F
Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School, Ann Arbor, 48109, USA.
J Pediatr Surg. 2009 Jan;44(1):151-5; discussion 155. doi: 10.1016/j.jpedsurg.2008.10.024.
Computed tomographic (CT) scanning has mostly replaced x-rays as an imaging modality, but concerns exist because of excess radiation, missed injuries, and whether it is the definitive procedure for intubated patients. The purpose of this study was to characterize missed cervical spine injuries (CSIs).
All pediatric (<18) trauma patients from 2004 to 2006 were analyzed. Age, sex, Injury Severity Score (ISS), mechanism, time, and missed injuries were reviewed. Flexion/extension views were used in patients with prolonged intubation. Descriptive statistics, chi(2), Student's t test, and bivariate correlation were used.
There were 1307 pediatric trauma patients admitted with 318 imaged for potential CSI. Computed tomography was the sole imaging study in 200, x-rays in 64, and both in 54. Time to C-spine clearance was similar for all modalities (P > .05). For CT, 34 (10.7%) were initially positive for CSI with 7 false-positives (FPs) and no false-negative (FN). There were 18 patients with CSI identified by x-ray, with 5 FPs and 5 FNs (missed injuries). The 5 FNs missed by x-ray were all positive by CT scan and required no intervention. None of the flexion/extension views revealed an additional injury. Sex, intubated patients, ISS, age, type, and injury location were not predictive of a missed injury (P > .05).The sensitivity of CT scan was 1.0, specificity was 0.976, and the positive predictive value was 79.4%. The sensitivity of plain x-ray was 61.5%, the specificity was 1.6%, and the positive predictive value was 61.5%.
Our data suggest that CT scans should be the primary modality to image a CSI. Flexion/extension views did not add to the decision making for C-spine clearance after CT evaluation.
计算机断层扫描（CT）已在很大程度上取代X线成为一种成像方式，但由于存在辐射过量、损伤漏诊以及它是否为插管患者的确定性检查等问题，仍备受关注。本研究旨在描述漏诊的颈椎损伤（CSI）情况。
对2004年至2006年所有儿科（<18岁）创伤患者进行分析。回顾患者的年龄、性别、损伤严重程度评分（ISS）、受伤机制、时间以及漏诊的损伤情况。对于插管时间较长的患者使用屈伸位片。采用描述性统计、卡方检验、学生t检验和双变量相关性分析。
共收治1307例儿科创伤患者，其中318例因可能存在CSI进行了影像学检查。200例仅行CT检查，64例仅行X线检查，54例两者都做了。所有检查方式的颈椎检查完成时间相似（P>.05）。对于CT检查，34例（10.7%）最初CSI检查呈阳性，其中7例假阳性（FP），无假阴性（FN）。X线检查发现18例CSI患者，其中5例假阳性和5例假阴性（漏诊损伤）。X线漏诊的5例假阴性经CT扫描均为阳性，且无需干预。屈伸位片均未发现额外损伤。性别、插管患者、ISS、年龄、损伤类型和损伤部位均不能预测漏诊损伤（P>.05）。CT扫描的敏感性为1.0，特异性为0.976，阳性预测值为79.4%。平片X线的敏感性为61.5%，特异性为1.6%，阳性预测值为61.5%。
我们的数据表明，CT扫描应作为CSI成像的主要方式。在CT评估后，屈伸位片对颈椎检查决策并无帮助。
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