TY - JOUR
T1 - Outcomes of pediatric patients with persistent midline cervical spine tenderness and negative imaging result after trauma
AU - Dorney, Kate
AU - Kimia, Amir
AU - Hannon, Megan
AU - Hennelly, Kara
AU - Meehan, William P.
AU - Proctor, Mark
AU - Mooney, David P.
AU - Glotzbecker, Michael
AU - Mannix, Rebekah
N1 - Publisher Copyright:
© 2015 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2015/11/1
Y1 - 2015/11/1
N2 - BACKGROUND There is little evidence to guide management of pediatric patients with persistent cervical spine tenderness after trauma but with negative initial imaging study findings. Our objective was to determine the prevalence of clinically significant cervical spine injury among pediatric blunt trauma patients discharged from the emergency department with negative imaging study findings but persistent midline cervical spine tenderness. METHODS We performed a single-center, retrospective study of subjects 1 year to 15 years of age discharged in a rigid cervical spine collar after blunt trauma over a 5-year period. We included patients with negative imaging results who were maintained in a collar because of persistent midline cervical spine tenderness. Primary outcome was clinically significant cervical spine injury. Secondary outcome was continued use of the collar after follow-up. Outcomes were ascertained from the medical record or self-report via telephone call. RESULTS A total of 307 subjects met inclusion criteria, of whom 289 (94.1%) had follow-up information available (89.6% in chart, 10.4% via telephone call). Of those with follow-up information, 189 (65.4%) had subspecialty follow-up in the spine clinic. Of those with spine clinic follow-up, 84.6% had the hard collar discontinued at the first visit (median time to visit, 10 days). Of subjects with spine clinic follow-up, 10.1% were left in the collar for persistent tenderness without findings on imaging and 2.1% had imaging findings related to their injury; none required surgical intervention. CONCLUSION A very small percentage of subjects with persistent midline cervical spine tenderness and normal radiographic study findings have a clinically significant cervical spine injury identified at follow-up. Referral for subspecialty evaluation may only be necessary in a small number of patients with persistent tenderness or concerning signs/symptoms. LEVEL OF EVIDENCE Therapeutic study, level IV.
AB - BACKGROUND There is little evidence to guide management of pediatric patients with persistent cervical spine tenderness after trauma but with negative initial imaging study findings. Our objective was to determine the prevalence of clinically significant cervical spine injury among pediatric blunt trauma patients discharged from the emergency department with negative imaging study findings but persistent midline cervical spine tenderness. METHODS We performed a single-center, retrospective study of subjects 1 year to 15 years of age discharged in a rigid cervical spine collar after blunt trauma over a 5-year period. We included patients with negative imaging results who were maintained in a collar because of persistent midline cervical spine tenderness. Primary outcome was clinically significant cervical spine injury. Secondary outcome was continued use of the collar after follow-up. Outcomes were ascertained from the medical record or self-report via telephone call. RESULTS A total of 307 subjects met inclusion criteria, of whom 289 (94.1%) had follow-up information available (89.6% in chart, 10.4% via telephone call). Of those with follow-up information, 189 (65.4%) had subspecialty follow-up in the spine clinic. Of those with spine clinic follow-up, 84.6% had the hard collar discontinued at the first visit (median time to visit, 10 days). Of subjects with spine clinic follow-up, 10.1% were left in the collar for persistent tenderness without findings on imaging and 2.1% had imaging findings related to their injury; none required surgical intervention. CONCLUSION A very small percentage of subjects with persistent midline cervical spine tenderness and normal radiographic study findings have a clinically significant cervical spine injury identified at follow-up. Referral for subspecialty evaluation may only be necessary in a small number of patients with persistent tenderness or concerning signs/symptoms. LEVEL OF EVIDENCE Therapeutic study, level IV.
KW - Cervical spine injury
KW - children
KW - rigid cervical spine collar
UR - http://www.scopus.com/inward/record.url?scp=84946117579&partnerID=8YFLogxK
U2 - 10.1097/TA.0000000000000847
DO - 10.1097/TA.0000000000000847
M3 - Article
C2 - 26496108
AN - SCOPUS:84946117579
SN - 2163-0755
VL - 79
SP - 822
EP - 827
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 5
ER -