Canadian C-spine Rule and the National Emergency X-Radiography Utilization Low-Risk Criteria for C-spine radiography in young trauma patients

https://doi.org/10.1016/j.jpedsurg.2009.01.044Get rights and content

Abstract

Purpose

The Canadian C-spine (cervical spine) Rule (CCR) and the National Emergency X-Radiography Utilization Low-Risk Criteria (NLC) are criteria designed to guide C-spine radiography in trauma patients. It is unclear how these 2 rules compare with young children.

Methods

This study retrospectively examined case-matched trauma patients 10 years or younger. Two cohorts were identified—cohort A where C-spine imaging was performed and cohort B where no imaging was conducted. The CCR and NLC criteria were then applied retrospectively to each cohort.

Results

Cohort A contained 125 cases and cohort B with 250 cases. Seven patients (3%) had significant C-spine injuries. In cohort A, NLC criteria could be applied in 108 (86.4%) of 125 and CCR in 109 (87.2%) of 125. National Emergency X-Radiography Utilization Low-Risk Criteria suggested that 70 (58.3%) cases required C-spine imaging compared to 93 (76.2%) by CCR. National Emergency X-Radiography Utilization Low-Risk Criteria missed 3 C-spine injuries, and CCR missed one. In cohort B, NLC criteria could be applied in 132 (88%) of 150 and CCR in 131 (87.3%) of 150. The NLC criteria identified 8 cases and CCR identified 13 cases that would need C-spine radiographs. Fisher's 2-sided Exact test demonstrated that CCR and NLC predictions were significantly different (P = .002) in both cohorts. The sensitivity of CCR was 86% and specificity was 94%, and the NLC had a sensitivity of 43% and a specificity of 96%.

Conclusions

Although CCR and NLC criteria may reduce the need for C-spine imaging in children 10 years and younger; they are not sensitive or specific enough to be used as currently designed.

Section snippets

Methods

This study was approved by the University of Michigan's Institutional Review Board (Ann Arbor, Mich). It is a retrospective case-matched design with trauma patients 10 years or younger. The University of Michigan CS Mott Children's Hospital is an American College of Surgeons-verified level I pediatric trauma center. The pediatric trauma registry from 2005 to 2007 was used to identify the patients. The pediatric trauma registry records all hospital trauma patients younger than 18 years.

Results

Between 2005 and 2007, 1307 pediatric trauma patients were identified for review. For 318 patients (24.3%), radiographic imaging was performed to rule out a possible CSI. Of these, 125 were 10 years or younger and comprised cohort A. Nine hundred eighty-nine patients did not undergo cervical spine imaging of which 150 children 10 years or younger were randomly identified from the trauma registry. This comprised cohort B. Injury characteristics are shown in Table 2. Seven patients (3%) had

Discussion

Clinical decision rules help clinicians make diagnostic and therapeutic decisions at the bedside. They are derived from original research and incorporate 3 or more variables from the history, examination, or simple tests [6], [7], [8]. Clinical decision rules have been developed for ankle injuries, deep vein thrombosis, and for patients who have pneumonia [6], [7], [18], [19], [20], [21]. There are 3 stages in developing a CDR. The first stage is to create/derive the rule; the second stage

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