Send to

Choose Destination
Pediatrics. 2019 Jul;144(1). pii: e20183221. doi: 10.1542/peds.2018-3221.

Cervical Spine Injury Risk Factors in Children With Blunt Trauma.

Author information

Departments of Pediatrics and
Department of Pediatrics and Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Departments of Pediatrics and.
Department of Pediatrics, Cincinnati Children's Hospital Medical Center and College of Medicine, University of Cincinnati, Cincinnati, Ohio; and.
Biostatistics, School of Medicine, Washington University, St Louis, Missouri.
Neurosurgery, Nationwide Children's Hospital and College of Medicine, The Ohio State University, Columbus, Ohio.
Departments of Emergency Medicine and Pediatrics, School of Medicine, University of California, Davis, Sacramento, California.



Adult prediction rules for cervical spine injury (CSI) exist; however, pediatric rules do not. Our objectives were to determine test accuracies of retrospectively identified CSI risk factors in a prospective pediatric cohort and compare them to a de novo risk model.


We conducted a 4-center, prospective observational study of children 0 to 17 years old who experienced blunt trauma and underwent emergency medical services scene response, trauma evaluation, and/or cervical imaging. Emergency department providers recorded CSI risk factors. CSIs were classified by reviewing imaging, consultations, and/or telephone follow-up. We calculated bivariable relative risks, multivariable odds ratios, and test characteristics for the retrospective risk model and a de novo model.


Of 4091 enrolled children, 74 (1.8%) had CSIs. Fourteen factors had bivariable associations with CSIs: diving, axial load, clotheslining, loss of consciousness, neck pain, inability to move neck, altered mental status, signs of basilar skull fracture, torso injury, thoracic injury, intubation, respiratory distress, decreased oxygen saturation, and neurologic deficits. The retrospective model (high-risk motor vehicle crash, diving, predisposing condition, neck pain, decreased neck mobility (report or exam), altered mental status, neurologic deficits, or torso injury) was 90.5% (95% confidence interval: 83.9%-97.2%) sensitive and 45.6% (44.0%-47.1%) specific for CSIs. The de novo model (diving, axial load, neck pain, inability to move neck, altered mental status, intubation, or respiratory distress) was 92.0% (85.7%-98.1%) sensitive and 50.3% (48.7%-51.8%) specific.


Our findings support previously identified pediatric CSI risk factors and prospective pediatric CSI prediction rule development.

[Available on 2020-07-01]

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center