1Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.
2Department of Neurosurgery, UPMC Children's Hospital of Pittsburgh, Pennsylvania.
J Neurosurg Pediatr. 2024 Jul 5;34(4):365-372. doi: 10.3171/2024.4.PEDS24102. Print 2024 Oct 1.
The Subaxial Cervical Spine Injury Classification (SLIC) score has not been previously validated for a pediatric population. The authors compared the SLIC treatment recommendations for pediatric subaxial cervical spine trauma with real-world pediatric spine surgery practice.
A retrospective cohort study at a pediatric level 1 trauma center was conducted in patients < 18 years of age evaluated for trauma from 2012 to 2021. An SLIC score was calculated for each patient, and the subsequent recommendations were compared with actual treatment delivered. Percentage misclassification, sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and area under the receiver operating characteristic (ROC) curve (AUC) were calculated.
Two hundred forty-three pediatric patients with trauma were included. Twenty-five patients (10.3%) underwent surgery and 218 were managed conservatively. The median SLIC score was 2 (interquartile range = 2). Sixteen patients (6.6%) had an SLIC score of 4, for which either conservative or surgical treatment is recommended; 27 children had an SLIC score ≥ 5, indicating a recommendation for surgical treatment; and 200 children had an SLIC score ≤ 3, indicating a recommendation for conservative treatment. Of the 243 patients, 227 received treatment consistent with SLIC score recommendations (p < 0.001). SLIC sensitivity in determining surgically treated patients was 79.2% and the specificity for accurately determining who underwent conservative treatment was 96.1%. The PPV was 70.3% and the NPV was 97.5%. There was a 5.7% misclassification rate (n = 13) using SLIC. Among patients for whom surgical treatment would be recommended by the SLIC, 29.6% (n = 8) did not undergo surgery; similarly, 2.5% (n = 5) of patients for whom conservative management would be recommended by the SLIC had surgery. The ROC curve for determining treatment received demonstrated excellent discriminative ability, with an AUC of 0.96 (OR 3.12, p < 0.001). Sensitivity decreased when the cohort was split by age (< 10 and ≥ 10 years old) to 0.5 and 0.82, respectively; specificity remained high at 0.98 and 0.94.
The SLIC scoring system recommended similar treatment when compared with the actual treatment delivered for traumatic subaxial cervical spine injuries in children, with a low misclassification rate and a specificity of 96%. These findings demonstrate that the SLIC can be useful in guiding treatment for pediatric patients with subaxial cervical spine injuries. Further investigation into the score in young children (< 10 years) using a multicenter cohort is warranted.
下颈椎损伤分类（SLIC）评分此前尚未在儿科人群中得到验证。作者比较了 SLIC 对儿科下颈椎创伤的治疗建议与实际儿科脊柱手术实践。
对 2012 年至 2021 年在一家儿科 1 级创伤中心因创伤而接受评估的 <18 岁患者进行了一项回顾性队列研究。对每位患者计算 SLIC 评分，并将随后的建议与实际治疗进行比较。计算百分比分类错误、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）以及接收器操作特征（ROC）曲线下面积（AUC）。
共纳入 243 例创伤性儿科患者。25 例（10.3%）患者接受手术治疗，218 例患者接受保守治疗。SLIC 评分中位数为 2（四分位距=2）。16 例（6.6%）患者的 SLIC 评分为 4，建议采用保守或手术治疗；27 名儿童的 SLIC 评分为≥5，建议手术治疗；200 名儿童的 SLIC 评分为≤3，建议保守治疗。在 243 名患者中，227 名患者接受了与 SLIC 评分建议一致的治疗（p<0.001）。SLIC 确定手术治疗患者的敏感性为 79.2%，准确确定接受保守治疗患者的特异性为 96.1%。PPV 为 70.3%，NPV 为 97.5%。使用 SLIC 会出现 5.7%的分类错误率（n=13）。根据 SLIC，建议进行手术治疗的患者中有 29.6%（n=8）未接受手术；同样，建议进行保守治疗的患者中有 2.5%（n=5）接受了手术。用于确定接受治疗的 ROC 曲线显示出出色的鉴别能力，AUC 为 0.96（OR 3.12，p<0.001）。当按年龄（<10 岁和≥10 岁）将队列分开时，敏感性分别降至 0.5 和 0.82；特异性仍保持在 0.98 和 0.94。
与儿童下颈椎创伤的实际治疗相比，SLIC 评分系统推荐了类似的治疗方法，其分类错误率较低，特异性为 96%。这些发现表明，SLIC 可用于指导儿童下颈椎损伤患者的治疗。需要进一步使用多中心队列研究来研究该评分在年龄较小的儿童（<10 岁）中的作用。
