{
  "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.",
  "authors": [
    {
      "affiliations": [
        "Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA"
      ],
      "name": "William Starr"
    },
    {
      "affiliations": [
        "Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA"
      ],
      "name": "Stephanie Iantorno"
    },
    {
      "affiliations": [
        "Taylor Family Department of Neurosurgery, Washington University in St Louis, St Louis, Missouri, USA"
      ],
      "name": "Jing Wang"
    },
    {
      "affiliations": [
        "Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "Richard Eldredge"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah, USA"
      ],
      "name": "Rajiv Iyer"
    },
    {
      "affiliations": [
        "Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA"
      ],
      "name": "Karch Smith"
    },
    {
      "affiliations": [
        "Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA"
      ],
      "name": "Natalya McNamara"
    },
    {
      "affiliations": [
        "Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA"
      ],
      "name": "Kezlyn Larsen"
    },
    {
      "affiliations": [
        "Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA"
      ],
      "name": "Stephen Fenton"
    },
    {
      "affiliations": [
        "Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA"
      ],
      "name": "Robert Swendiman"
    },
    {
      "affiliations": [
        "Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA"
      ],
      "name": "Katie Russell"
    }
  ],
  "title": "Pediatric cervical spine clearance: a 10-year evaluation of X-ray in evaluable patients at a level 1 pediatric trauma center",
  "uid": "92b15d15-51a3-50f6-9e59-7e0508375feb"
}