Validation of the Subaxial Cervical Spine Injury Classification score in children: a single-institution experience at a level 1 pediatric trauma center.

Autor:	Piazza MG; 1Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.; 2Department of Neurosurgery, UPMC Children's Hospital of Pittsburgh, Pennsylvania., Ravindra VM; 1Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.; 3Division of Pediatric Neurosurgery, Rady Children's Hospital, San Diego, California.; 4Department of Neurological Surgery, Naval Medical Center San Diego, California., Earl ER; 1Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.; 5Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah., Ludwick A; 1Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah., Sarriera Valentin G; 1Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.; 6Larner College of Medicine at the University of Vermont, Burlington, Vermont; and., Dailey AT; 1Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah., Kestle JRW; 1Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah., Russell KW; 7Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah., Brockmeyer DL; 1Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah., Iyer RR; 1Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Pediatrics [J Neurosurg Pediatr] 2024 Jul 05; Vol. 34 (4), pp. 365-372. Date of Electronic Publication: 2024 Jul 05 (Print Publication: 2024).
DOI:	10.3171/2024.4.PEDS24102
Abstrakt:	Objective: The Subaxial Cervical Spine Injury Classification (SLIC) score has not been previously validated for a pediatric population. The authors compared the SLIC treatment recommendations for pediatric subaxial cervical spine trauma with real-world pediatric spine surgery practice. Methods: A retrospective cohort study at a pediatric level 1 trauma center was conducted in patients < 18 years of age evaluated for trauma from 2012 to 2021. An SLIC score was calculated for each patient, and the subsequent recommendations were compared with actual treatment delivered. Percentage misclassification, sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and area under the receiver operating characteristic (ROC) curve (AUC) were calculated. Results: Two hundred forty-three pediatric patients with trauma were included. Twenty-five patients (10.3%) underwent surgery and 218 were managed conservatively. The median SLIC score was 2 (interquartile range = 2). Sixteen patients (6.6%) had an SLIC score of 4, for which either conservative or surgical treatment is recommended; 27 children had an SLIC score ≥ 5, indicating a recommendation for surgical treatment; and 200 children had an SLIC score ≤ 3, indicating a recommendation for conservative treatment. Of the 243 patients, 227 received treatment consistent with SLIC score recommendations (p < 0.001). SLIC sensitivity in determining surgically treated patients was 79.2% and the specificity for accurately determining who underwent conservative treatment was 96.1%. The PPV was 70.3% and the NPV was 97.5%. There was a 5.7% misclassification rate (n = 13) using SLIC. Among patients for whom surgical treatment would be recommended by the SLIC, 29.6% (n = 8) did not undergo surgery; similarly, 2.5% (n = 5) of patients for whom conservative management would be recommended by the SLIC had surgery. The ROC curve for determining treatment received demonstrated excellent discriminative ability, with an AUC of 0.96 (OR 3.12, p < 0.001). Sensitivity decreased when the cohort was split by age (< 10 and ≥ 10 years old) to 0.5 and 0.82, respectively; specificity remained high at 0.98 and 0.94. Conclusions: The SLIC scoring system recommended similar treatment when compared with the actual treatment delivered for traumatic subaxial cervical spine injuries in children, with a low misclassification rate and a specificity of 96%. These findings demonstrate that the SLIC can be useful in guiding treatment for pediatric patients with subaxial cervical spine injuries. Further investigation into the score in young children (< 10 years) using a multicenter cohort is warranted.
Databáze:	MEDLINE
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