Triage tools for detecting cervical spine injury in pediatric trauma patients

• Published in: Cochrane database of systematic reviews 2017-12, Vol.12 (12), p.CD011686-CD011686
• Main Authors: Slaar, Annelie, Fockens, M M, Wang, Junfeng, Maas, Mario, Wilson, David J, Goslings, J Carel, Schep, Niels Wl, van Rijn, Rick R
• Format: Article
• Language: English
• Subjects: Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - injuries; Checklist; Child; Child health; Cohort Studies; Decision Support Techniques; Diagnosis; Humans; Magnetic Resonance Imaging; Population; Radiography; Reference Standards; Review Type; Rheumatology; Spinal Injuries - diagnosis; Spinal Injuries - diagnostic imaging; Spinal Injuries - etiology; Tomography, X-Ray Computed; Triage - methods; Wounds, Nonpenetrating - complications; Wounds, Nonpenetrating - diagnostic imaging
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD011686.pub2

Pediatric cervical spine injury (CSI) after blunt trauma is rare. Nonetheless, missing these injuries can have severe consequences. To prevent the overuse of radiographic imaging, two clinical decision tools have been developed: The National Emergency X-Radiography Utilization Study (NEXUS) criteria and the Canadian C-spine Rule (CCR). Both tools are proven to be accurate in deciding whether or not diagnostic imaging is needed in adults presenting for blunt trauma screening at the emergency department. However, little information is known about the accuracy of these triage tools in a pediatric population. To determine the diagnostic accuracy of the NEXUS criteria and the Canadian C-spine Rule in a pediatric population evaluated for CSI following blunt trauma. We searched the following databases to 24 February 2015: CENTRAL, MEDLINE, MEDLINE Non-Indexed and In-Process Citations, PubMed, Embase, Science Citation Index, ProQuest Dissertations & Theses Database, OpenGrey, ClinicalTrials.gov, World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, the Health Technology Assessment, and the Aggressive Research Intelligence Facility. We included all retrospective and prospective studies involving children following blunt trauma that evaluated the accuracy of the NEXUS criteria, the Canadian C-spine Rule, or both. Plain radiography, computed tomography (CT) or magnetic resonance imaging (MRI) of the cervical spine, and follow-up were considered as adequate reference standards. Two review authors independently assessed the quality of included studies using the QUADAS-2 checklists. They extracted data on study design, patient characteristics, inclusion and exclusion criteria, clinical parameters, target condition, reference standard, and the diagnostic two-by-two table. We calculated and plotted sensitivity, specificity and negative predictive value in ROC space, and constructed forest plots for visual examination of variation in test accuracy. Three cohort studies were eligible for analysis, including 3380 patients ; 96 children were diagnosed with CSI. One study evaluated the accuracy of the Canadian C-spine Rule and the NEXUS criteria, and two studies evaluated the accuracy of the NEXUS criteria. The studies were of moderate quality. Due to the small number of included studies and the diverse outcomes of those studies, we could not describe a