儿童颈椎评估：在一家一级儿童创伤中心对可评估患者进行X线检查的10年评估
Pediatric cervical spine clearance: a 10-year evaluation of X-ray in evaluable patients at a level 1 pediatric trauma center.
作者信息
Starr William, Iantorno Stephanie, Wang Jing, Eldredge Richard, Iyer Rajiv, Smith Karch, McNamara Natalya, Larsen Kezlyn, Fenton Stephen, Swendiman Robert, Russell Katie
机构信息
Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA.
Taylor Family Department of Neurosurgery, Washington University in St Louis, St Louis, Missouri, USA.
出版信息
Trauma Surg Acute Care Open. 2025 Aug 3;10(3):e001539. doi: 10.1136/tsaco-2024-001539. eCollection 2025.
OBJECTIVES
Cervical spine (c-spine) X-ray (XR) remains an important tool for pediatric trauma patients. XR is a low radiation alternative to multidetector CT (MDCT). Our primary aims were to analyze the sensitivity of a negative c-spine XR and to analyze what factors lead to additional imaging after a negative c-spine XR.
METHODS
A retrospective cohort study was conducted at a level 1 pediatric trauma center from 2012 to 2021. We compared the group with negative c-spine XR and no additional imaging to the group with negative c-spine XR followed by additional c-spine MDCT and/or MRI.
RESULTS
There were 2,081 negative XRs and 1,974 (95%) had their c-spines cleared without additional imaging. No patient required an operation for a clinically significant c-spine injury in this group, and we consider this no missed injuries. The remaining 108 patients had additional c-spine imaging after negative c-spine XR for c-spine clearance (24 MDCT, 76 MRI, 8 MDCT and MRI). Indications for additional c-spine imaging were pain (48.1%), Glasgow Coma Scale (GCS) score ≤14 (43.5%), and paresthesia (8.3%). Patients who received additional imaging were more likely to have a GCS score ≤12 (25.4% vs 4.1%), Injury Severity Score >15 (21.9% vs 8.1%), Level 1 Trauma activation (21% vs 5%), Abbreviated Injury Scale head score of 4 or 5 (29% vs 5%), be intubated (30% vs 2%), and have non-accidental trauma as their mechanism of injury (20% vs 1%) (p value<0.0001, for all). Five patients who received additional imaging were treated with a cervical collar, but no operative intervention.
CONCLUSIONS
In this cohort, screening XR had a sensitivity of 100% for clinically significant c-spine injuries. GCS was the most significant predictor of obtaining additional imaging. A negative XR combined with a normal physical examination in an evaluable pediatric patient is a safe way of clearing the c-spine.
LEVEL OF EVIDENCE
Study contains level III evidence.
目的
颈椎（C 型脊柱）X 线检查（XR）仍是儿科创伤患者的重要检查手段。XR 是一种低辐射的多排螺旋 CT（MDCT）替代检查方法。我们的主要目的是分析阴性颈椎 XR 的敏感性，并分析哪些因素导致阴性颈椎 XR 后仍需进一步影像学检查。
方法
在一家一级儿科创伤中心进行了一项回顾性队列研究，研究时间为 2012 年至 2021 年。我们将颈椎 XR 阴性且未进行进一步影像学检查的组与颈椎 XR 阴性后又进行了颈椎 MDCT 和/或 MRI 检查的组进行了比较。
结果
共有 2081 例 XR 检查结果为阴性，其中 1974 例（95%）无需进一步影像学检查即可排除颈椎损伤。该组中没有患者因具有临床意义的颈椎损伤而需要手术治疗，我们认为这没有漏诊病例。其余 108 例患者在颈椎 XR 阴性后进行了额外的颈椎影像学检查以排除颈椎损伤（24 例进行了 MDCT 检查，76 例进行了 MRI 检查，8 例同时进行了 MDCT 和 MRI 检查）。进行额外颈椎影像学检查的指征包括疼痛（48.1%）、格拉斯哥昏迷量表（GCS）评分≤14（43.5%）和感觉异常（8.3%）。接受额外影像学检查的患者更有可能 GCS 评分≤12（25.4% 对 4.1%）、损伤严重度评分>15（21.9% 对 8.1%）、一级创伤激活（21% 对 5%）、简明损伤定级头部评分为 4 或 5（29% 对 5%）、已插管（30% 对 2%）以及损伤机制为非意外创伤（20% 对 1%）（所有 p 值均<0.0001）。5 例接受额外影像学检查的患者使用了颈托治疗，但未进行手术干预。
结论
在该队列中，筛查 XR 对具有临床意义的颈椎损伤的敏感性为 100%。GCS 是进行额外影像学检查的最显著预测因素。对于可评估的儿科患者，阴性 XR 结合正常体格检查是排除颈椎损伤的安全方法。
证据水平
研究包含 III 级证据。
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