ArticleTrauma surgery & acute care open2025
Pediatric cervical spine clearance: a 10-year evaluation of X-ray in evaluable patients at a level 1 pediatric trauma center.
Article in Trauma surgery & acute care open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Low radiation, high yield: reclaiming the first-line role of radiographs.Trauma surgery & acute care open · 2025Article
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Objectives: Cervical spine (c-spine) X-ray (XR) remains an important tool for pediatric trauma patients. XR is a low radiation alternative to multidetector CT (MDCT). Our primary aims were to analyze the sensitivity of a negative c-spine XR and to analyze what factors lead to additional imaging after a negative c-spine XR. Methods: A retrospective cohort study was conducted at a level 1 pediatric trauma center from 2012 to 2021. We compared the group with negative c-spine XR and no additional imaging to the group with negative c-spine XR followed by additional c-spine MDCT and/or MRI. Results: There were 2,081 negative XRs and 1,974 (95%) had their c-spines cleared without additional imaging. No patient required an operation for a clinically significant c-spine injury in this group, and we consider this no missed injuries. The remaining 108 patients had additional c-spine imaging after negative c-spine XR for c-spine clearance (24 MDCT, 76 MRI, 8 MDCT and MRI). Indications for additional c-spine imaging were pain (48.1%), Glasgow Coma Scale (GCS) score ≤14 (43.5%), and paresthesia (8.3%). Patients who received additional imaging were more likely to have a GCS score ≤12 (25.4% vs 4.1%), Injury Severity Score >15 (21.9% vs 8.1%), Level 1 Trauma activation (21% vs 5%), Abbreviated Injury Scale head score of 4 or 5 (29% vs 5%), be intubated (30% vs 2%), and have non-accidental trauma as their mechanism of injury (20% vs 1%) (p value<0.0001, for all). Five patients who received additional imaging were treated with a cervical collar, but no operative intervention. Conclusions: In this cohort, screening XR had a sensitivity of 100% for clinically significant c-spine injuries. GCS was the most significant predictor of obtaining additional imaging. A negative XR combined with a normal physical examination in an evaluable pediatric patient is a safe way of clearing the c-spine. Level of evidence: Study contains level III evidence.
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