488 - Accuracy of Clinical Suspicion for Cervical Spine Injury

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 488
Publication Number: 488.311

Rebecca K. Burger, Emory University School of Medicine, Atlanta, GA, United States; Fahd A. Ahmad, Washington University in St. Louis, St. Louis, MO, United States; Caleb E. Ward, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Emily Startup, University of Utah School of Medicine, Roseville, CA, United States; Lawrence J. Cook, University of Utah, Salt Lake City, UT, United States; Pradip P.. Chaudhari, Children's Hospital Los Angeles, Los Angeles, CA, United States; Daniel Corwin, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Monica Harding, University of Utah, SAINT JOHNS, FL, United States; Lauren Riney, Cincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine, Cincinnati, OH, United States; Alexander J. Rogers, University of Michigan Medical School, Ann Arbor, MI, United States; Leah Tzimenatos, University of California, Davis, School of Medicine, Sacramento, CA, United States; Kenneth Yen, UTSW, Dallas, TX, United States; Julie C.. Leonard, Nationwide Children's Hospital/The Ohio State University College of Medicine, Columbus, OH, United States

Presenting Author(s)

Rebecca K. Burger, MD (she/her/hers)

Assistant Professor of Pediatrics and Emergency Medicine
Emory University School of Medicine and Children's Healthcare of Atlatna
Atlanta, Georgia, United States

Background: Assessing for cervical spine injury (CSI) is a key aspect of pediatric blunt trauma evaluations in the prehospital and emergency department (ED) settings. Decisions on the use of spinal motion restriction (SMR) in the pre-hospital setting and cervical spine imaging in the ED setting are based on Emergency Medical Services (EMS), ED, and surgical provider clinical suspicion for CSI.

Objective: We sought to determine the accuracy of the clinical suspicion of EMS, ED, and surgical providers for the presence of CSI in children experiencing blunt trauma.

Design/Methods: This study was a planned secondary analysis of data collected for the Pediatric Emergency Care Applied Research Network (PECARN) NIH-funded project entitled Development and Testing of a Pediatric CSI Risk Assessment Tool. This was a prospective, 18-center, cohort study of children ages 0-17 years who were exposed to blunt trauma. ED providers were asked to document their clinical suspicion of CSI using a self-reported 5-point categorical scale (< 1%, 1%-5%, 6%-10%, 11%-50%, >50%). We also asked EMS and surgical providers to document their suspicion when involved in patient care. Providers who documented their clinical suspicion after knowing results of cervical spine imaging were excluded. Suspicion was subsequently dichotomized into low suspicion (< 1%), and high suspicion ( >10%). Determination of CSI was based on review of cervical spine imaging and phone follow-up when imaging was not obtained.

Results: There were 18,232 eligible patients (Figure 1), the median age was 8 years, and the incidence of CSI was 1.3% (Table 1). ED, EMS, and surgical providers documented low suspicion for CSI in 78%, 70%, and 70% of children respectively, while they documented high suspicion for CSI in 1.6%, 6.3%, and 4.3% respectively. When stratified by presence of CSI (yes/no), accuracy for ED providers was 99.7% for low suspicion and 21.9% for high suspicion (Table 2 ). For EMS providers, accuracy was 99.6% and 7.5% and for surgical providers 99.5% and 20% for low and high suspicion respectively.

Conclusion(s): We determined that EMS, ED, and surgical providers were able to accurately identify patients at low risk for CSI in nearly 100% of cases. Their accuracy was significantly lower in identifying patients at high risk for injury, indicating a CSI risk prediction tool may allow for more accurate assignment of CSI clinical suspicion which will reduce unnecessary prehospital SMR and cervical spine imaging in the ED.