Spine Injury Criteria for Children Being Challenged

CORONADO, CALIF. — Reports are challenging the validity of the five National Emergency X-Radiography Utilization Study criteria to diagnose spine injury in children.

The criteria (posterior midline cervical tenderness; no evidence of intoxication; normal level of alertness; no focal neurologic deficit; and no painful, distracting injury) were established in a study of 34,069 trauma victims (N. Engl. J. Med. 2000;343:94–9). Of these, 818 (2.4%) had cervical spine injury.

The researchers reported the criteria were 99% sensitive for cervical spine injury and 99.6% sensitive for clinically significant cervical spine injury in adults. Specificity was 12.9% in both groups.

In a subset analysis of 3,065 children from the National Emergency X-Radiography Utilization Study (NEXUS) study, 30 had cervical spine injuries (Pediatrics 2001;108:E20). The NEXUS criteria for detecting cervical spine injury were 100% sensitive and only 19.9% specific. However, none of the children studied were less than 2 years old and only 817 (27%) were younger than age 8 years.

“Until we come up with pediatric-specific criteria, it's reasonable to apply the NEXUS criteria to awake and alert patients,” Dr. Julie C. Leonard said at a meeting sponsored by the American College of Emergency Physicians. “However, if you have a high index of suspicion by either mechanism or self-reported pain, you should use your clinical acumen.”

A recent 20-year review that applied the NEXUS criteria to 190 children with cervical spine injury found the criteria were 94% sensitive among children aged less than 8 and 100% sensitive in those older than 8 (Neurosurgery 2008;62:700–8). A Pediatric Emergency Care Applied Research Network study found the NEXUS criteria were 83% sensitive among 539 children with spinal injury who presented to the emergency department. Of the 90 children missed by the NEXUS criteria, 58 (64%) were younger than 8 years of age.

Dr. Leonard, of Washington University, St. Louis, said a risk-stratification system is needed. High-risk populations also must be considered, like those with Down syndrome or juvenile idiopathic arthritis.

Dr. Leonard disclosed no conflicts.

CORONADO, CALIF. — Reports are challenging the validity of the five National Emergency X-Radiography Utilization Study criteria to diagnose spine injury in children.

The criteria (posterior midline cervical tenderness; no evidence of intoxication; normal level of alertness; no focal neurologic deficit; and no painful, distracting injury) were established in a study of 34,069 trauma victims (N. Engl. J. Med. 2000;343:94–9). Of these, 818 (2.4%) had cervical spine injury.

The researchers reported the criteria were 99% sensitive for cervical spine injury and 99.6% sensitive for clinically significant cervical spine injury in adults. Specificity was 12.9% in both groups.

In a subset analysis of 3,065 children from the National Emergency X-Radiography Utilization Study (NEXUS) study, 30 had cervical spine injuries (Pediatrics 2001;108:E20). The NEXUS criteria for detecting cervical spine injury were 100% sensitive and only 19.9% specific. However, none of the children studied were less than 2 years old and only 817 (27%) were younger than age 8 years.

“Until we come up with pediatric-specific criteria, it's reasonable to apply the NEXUS criteria to awake and alert patients,” Dr. Julie C. Leonard said at a meeting sponsored by the American College of Emergency Physicians. “However, if you have a high index of suspicion by either mechanism or self-reported pain, you should use your clinical acumen.”

A recent 20-year review that applied the NEXUS criteria to 190 children with cervical spine injury found the criteria were 94% sensitive among children aged less than 8 and 100% sensitive in those older than 8 (Neurosurgery 2008;62:700–8). A Pediatric Emergency Care Applied Research Network study found the NEXUS criteria were 83% sensitive among 539 children with spinal injury who presented to the emergency department. Of the 90 children missed by the NEXUS criteria, 58 (64%) were younger than 8 years of age.

Dr. Leonard, of Washington University, St. Louis, said a risk-stratification system is needed. High-risk populations also must be considered, like those with Down syndrome or juvenile idiopathic arthritis.

Dr. Leonard disclosed no conflicts.

CORONADO, CALIF. — Reports are challenging the validity of the five National Emergency X-Radiography Utilization Study criteria to diagnose spine injury in children.

The criteria (posterior midline cervical tenderness; no evidence of intoxication; normal level of alertness; no focal neurologic deficit; and no painful, distracting injury) were established in a study of 34,069 trauma victims (N. Engl. J. Med. 2000;343:94–9). Of these, 818 (2.4%) had cervical spine injury.

The researchers reported the criteria were 99% sensitive for cervical spine injury and 99.6% sensitive for clinically significant cervical spine injury in adults. Specificity was 12.9% in both groups.

In a subset analysis of 3,065 children from the National Emergency X-Radiography Utilization Study (NEXUS) study, 30 had cervical spine injuries (Pediatrics 2001;108:E20). The NEXUS criteria for detecting cervical spine injury were 100% sensitive and only 19.9% specific. However, none of the children studied were less than 2 years old and only 817 (27%) were younger than age 8 years.

“Until we come up with pediatric-specific criteria, it's reasonable to apply the NEXUS criteria to awake and alert patients,” Dr. Julie C. Leonard said at a meeting sponsored by the American College of Emergency Physicians. “However, if you have a high index of suspicion by either mechanism or self-reported pain, you should use your clinical acumen.”

A recent 20-year review that applied the NEXUS criteria to 190 children with cervical spine injury found the criteria were 94% sensitive among children aged less than 8 and 100% sensitive in those older than 8 (Neurosurgery 2008;62:700–8). A Pediatric Emergency Care Applied Research Network study found the NEXUS criteria were 83% sensitive among 539 children with spinal injury who presented to the emergency department. Of the 90 children missed by the NEXUS criteria, 58 (64%) were younger than 8 years of age.

Dr. Leonard, of Washington University, St. Louis, said a risk-stratification system is needed. High-risk populations also must be considered, like those with Down syndrome or juvenile idiopathic arthritis.

Dr. Leonard disclosed no conflicts.