TY - JOUR
T1 - Pediatric Cervical Spine Injury Following Blunt Trauma in Children Younger Than 3 Years The PEDSPINE II Study
AU - Luckhurst, Casey M.
AU - Wiberg, Holly M.
AU - Brown, Rebeccah L.
AU - Bruch, Steven W.
AU - Chandler, Nicole M.
AU - Danielson, Paul D.
AU - Draus, John M.
AU - Fallat, Mary E.
AU - Gaines, Barbara A.
AU - Haynes, Jeffrey H.
AU - Inaba, Kenji
AU - Islam, Saleem
AU - Kaminski, Stephen S.
AU - Kang, Hae Sung
AU - Madabhushi, Vashisht V.
AU - Murray, Jason
AU - Nance, Michael L.
AU - Qureshi, Faisal G.
AU - Rubsam, Jeanne
AU - Stylianos, Steven
AU - Bertsimas, Dimitris J.
AU - Masiakos, Peter T.
N1 - Publisher Copyright:
© 2023 American Medical Association. All rights reserved.
PY - 2023/11/8
Y1 - 2023/11/8
N2 - IMPORTANCE There is variability in practice and imaging usage to diagnose cervical spine injury (CSI) following blunt trauma in pediatric patients. OBJECTIVE To develop a prediction model to guide imaging usage and to identify trends in imaging and to evaluate the PEDSPINE model. DESIGN, SETTING, AND PARTICIPANTS This cohort study included pediatric patients (<3 years years) following blunt trauma between January 2007 and July 2017. Of 22 centers in PEDSPINE, 15 centers, comprising level 1 and 2 stand-alone pediatric hospitals, level 1 and 2 pediatric hospitals within an adult hospital, and level 1 adult hospitals, were included. Patients who died prior to obtaining cervical spine imaging were excluded. Descriptive analysis was performed to describe the population, use of imaging, and injury patterns. PEDSPINE model validation was performed. A new algorithm was derived using clinical criteria and formulation of a multiclass classification problem. Analysis took place from January to October 2022. EXPOSURE Blunt trauma. MAIN OUTCOMES AND MEASURES Primary outcome was CSI. The primary and secondary objectives were predetermined. RESULTS The current study, PEDSPINE II, included 9389 patients, of which 128 (1.36%) had CSI, twice the rate in PEDSPINE (0.66%). The mean (SD) age was 1.3 (0.9) years; and 70 patients (54.7%) were male. Overall, 7113 children (80%) underwent cervical spine imaging, compared with 7882 (63%) in PEDSPINE. Several candidate models were fitted for the multiclass classification problem. After comparative analysis, the multinomial regression model was chosen with one-vs-rest area under the curve (AUC) of 0.903 (95% CI, 0.836-0.943) and was able to discriminate between bony and ligamentous injury. PEDSPINE and PEDSPINE II models' ability to identify CSI were compared. In predicting the presence of any injury, PEDSPINE II obtained a one-vs-rest AUC of 0.885 (95% CI, 0.804-0.934), outperforming the PEDSPINE score (AUC, 0.845; 95% CI, 0.769-0.915). CONCLUSION AND RELEVANCE This study found wide clinical variability in the evaluation of pediatric trauma patients with increased use of cervical spine imaging. This has implications of increased cost, increased radiation exposure, and a potential for overdiagnosis. This prediction tool could help to decrease the use of imaging, aid in clinical decision-making, and decrease hospital resource use and cost.
AB - IMPORTANCE There is variability in practice and imaging usage to diagnose cervical spine injury (CSI) following blunt trauma in pediatric patients. OBJECTIVE To develop a prediction model to guide imaging usage and to identify trends in imaging and to evaluate the PEDSPINE model. DESIGN, SETTING, AND PARTICIPANTS This cohort study included pediatric patients (<3 years years) following blunt trauma between January 2007 and July 2017. Of 22 centers in PEDSPINE, 15 centers, comprising level 1 and 2 stand-alone pediatric hospitals, level 1 and 2 pediatric hospitals within an adult hospital, and level 1 adult hospitals, were included. Patients who died prior to obtaining cervical spine imaging were excluded. Descriptive analysis was performed to describe the population, use of imaging, and injury patterns. PEDSPINE model validation was performed. A new algorithm was derived using clinical criteria and formulation of a multiclass classification problem. Analysis took place from January to October 2022. EXPOSURE Blunt trauma. MAIN OUTCOMES AND MEASURES Primary outcome was CSI. The primary and secondary objectives were predetermined. RESULTS The current study, PEDSPINE II, included 9389 patients, of which 128 (1.36%) had CSI, twice the rate in PEDSPINE (0.66%). The mean (SD) age was 1.3 (0.9) years; and 70 patients (54.7%) were male. Overall, 7113 children (80%) underwent cervical spine imaging, compared with 7882 (63%) in PEDSPINE. Several candidate models were fitted for the multiclass classification problem. After comparative analysis, the multinomial regression model was chosen with one-vs-rest area under the curve (AUC) of 0.903 (95% CI, 0.836-0.943) and was able to discriminate between bony and ligamentous injury. PEDSPINE and PEDSPINE II models' ability to identify CSI were compared. In predicting the presence of any injury, PEDSPINE II obtained a one-vs-rest AUC of 0.885 (95% CI, 0.804-0.934), outperforming the PEDSPINE score (AUC, 0.845; 95% CI, 0.769-0.915). CONCLUSION AND RELEVANCE This study found wide clinical variability in the evaluation of pediatric trauma patients with increased use of cervical spine imaging. This has implications of increased cost, increased radiation exposure, and a potential for overdiagnosis. This prediction tool could help to decrease the use of imaging, aid in clinical decision-making, and decrease hospital resource use and cost.
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U2 - 10.1001/jamasurg.2023.4213
DO - 10.1001/jamasurg.2023.4213
M3 - Article
C2 - 37703025
AN - SCOPUS:85176509372
SN - 2168-6254
VL - 158
SP - 1126
EP - 1132
JO - JAMA Surgery
JF - JAMA Surgery
IS - 11
ER -