Fischer Victoria E, Mahadev Vaidehi M, Bethel Jacob A, Quirarte Jaime A, Hammack Robert J, Gragnaniello Cristian, Tarasiewicz Izabela
Department of Neurosurgery, University of Texas Health at San Antonio, San Antonio, TX, USA.
University Hospital, University Health System, San Antonio, TX, USA.
Childs Nerv Syst. 2024 Dec 16;41(1):58. doi: 10.1007/s00381-024-06716-x.
Pediatric cervical spine injury (pCSI) is rare. Physiological differences necessitate alternate management from adults. Yet, no standardized pediatric protocols exist. Previous investigations applying adult-validated clinical decision rules (CDRs)-NEXUS Criteria (NX) and Canadian C-spine Rules (CCR)-to children are mixed. We hypothesized a combined NX + CCR approach applied at a delayed 24-h time point would enhance screening efficacy in select patients.
We conducted a retrospective review of a prospectively-collected database over 15 months at a pediatric-capable Level-1 trauma center. Age and mechanism determined initial inclusion. NX and CCR criteria were collected and retroactively applied on arrival (T0) and 24 h later (T1). Statistical analyses were performed in SPSS.
A total of 306 patients met inclusion. Current practices compel computed tomography (CT) overuse for craniocervical evaluations: 298 (97.4%) underwent ≥ 1 CT. Of cervical spines imaged (n = 175), 161 (92.0%) underwent CT while 74 (42.3%) underwent magnetic resonance imaging with 14 (18.9%) completed after 72 h. Of collars placed on arrival (n = 181), 136 (75.1%) were cleared before discharge with 86 (63.2%) CTs denoting preferred clearance modality; CT utilization was unchanged when stratified by age < 5 years (p = 0.819). Notably, we found more patients met NX + CCR criteria at T1 versus T0 (p = 0.008) without missed pCSI resulting in imaging overutilization in 15 (8.6%) patients.
We showed incorporating a 24-h time delay before a second CDR reapplication may enhance screening efficacy in pCSI. Our new algorithm combines these findings with other literature-based recommendations and may represent a standardizable option for evaluating pCSI in the acute trauma setting.
小儿颈椎损伤（pCSI）较为罕见。生理差异使得其治疗方式与成人不同。然而，目前尚无标准化的儿科治疗方案。先前将适用于成人的临床决策规则（CDRs）——NEXUS标准（NX）和加拿大颈椎规则（CCR）应用于儿童的研究结果不一。我们假设在延迟24小时的时间点应用NX + CCR联合方法会提高特定患者的筛查效率。
我们对一家具备儿科治疗能力的一级创伤中心在15个月内前瞻性收集的数据库进行了回顾性研究。根据年龄和受伤机制确定初始纳入标准。收集NX和CCR标准，并在患者入院时（T0）和24小时后（T1）进行追溯应用。在SPSS中进行统计分析。
共有306例患者符合纳入标准。目前的做法导致在颅颈评估中计算机断层扫描（CT）过度使用：298例（97.4%）接受了≥1次CT检查。在接受颈椎成像的患者中（n = 175），161例（92.0%）接受了CT检查，而74例（42.3%）接受了磁共振成像检查，其中14例（18.9%）在72小时后完成。在入院时佩戴颈托的患者中（n = 181），136例（75.1%）在出院前解除颈托，其中86例（63.2%）通过CT检查作为首选的解除颈托方式；按年龄<5岁分层时，CT使用率无变化（p = 0.819）。值得注意的是，我们发现与T0相比，在T1时符合NX + CCR标准的患者更多（p = 0.008），且没有遗漏pCSI病例，但有15例（8.6%）患者因成像过度使用。
我们表明，在第二次重新应用CDR之前延迟24小时可能会提高pCSI的筛查效率。我们的新算法将这些发现与其他基于文献的建议相结合，可能代表了在急性创伤环境中评估pCSI的一种可标准化的选择。
