Clinical prediction of cervical spine injuries in children. Radiographic abnormalities
I. Rachesky, W. T. Boyce, B. Duncan, J. Bjelland and B. Sibley
During the seven-year period from 1976 through 1982, 2133 cervical spine
radiographs were obtained for children less than 18 years of age at two
hospitals in Tucson. Twenty-five children (1.2%) had x-ray evidence of a
cervical spine injury, with a male to female ratio of 4:1. Vehicular
accidents accounted for 36% of cervical spine radiographic abnormalities,
and sports or playground accidents accounted for an additional 36%. In an
attempt to find clinical predictors that might identify x-ray
abnormalities, we reviewed the medical records of these 25 children with
abnormalities and 713 randomly selected children without x-ray evidence of
cervical spine injuries for the following: method of injury, presenting
complaints, physical examination findings, therapy, and complications. No
single clinical predictor had a sensitivity of 100% when considered in
isolation, but clinical assessment consisting of EITHER a complaint of neck
pain OR involvement in a vehicular accident with head trauma would have
correctly identified all 25 cases of cervical spine injury. If this
information had been used prospectively, the number of cervical spine
radiographs ordered would have been reduced by 32%. We conclude that the
use of this clinical "marker" would have positively identified all children
with cervical spine injuries and would have reduced by one third the cost
and radiation exposure associated with cervical spine radiographs. Because
of the serious consequences of missing a cervical spine injury, we suggest
that other studies confirm these results before this information is
accepted as a recommendation.
