The advantage of these risk factors is that they were based on a pediatric population and demonstrated 98% sensitivity. However, these risk factors have not yet been prospectively validated in a pediatric population. We decided to use the PECARN age <16 years to frame the variants in this document. There has only been one study evaluating predictors of cervical spine injury in blunt trauma in patients <3 years of age [19]. The study used a large cohort and a retrospective study design and there were no subsequent validation studies [19] (see Appendix 1). Several congenital disorders have been associated with a higher risk for cervical injury in athletes. For example, increased ligamentous laxity in patients with Down syndrome is associated with higher rates of spinal cord injury; patients with achondroplasia and spinal stenosis are at risk for significant spinal cord injury at the cervicomedullary junction with hyperflexion and hyperextension; similar injury risks related to atlantoaxial instability probably apply in patients with mucopolysaccharidosis type VI and Marfan syndrome [20]. In addition, children receiving systemic glucosteroid therapy for inflammatory diseases, such as juvenile dermatomyositis, juvenile idiopathic arthritis, systemic lupus erythematosus, systemic arthritis, and systemic vasculitis, are at higher risk for vertebral body fractures [21,22]. Children may have cartilaginous injuries that are not visualized on radiographs but are better detected with MRI [24]. In adults, MRI is the modality of choice to evaluate thoracolumbar trauma patients with neurologic deficits, abnormal CT scans, and high clinical suspicion despite negative radiographic evaluation [25]. Recently, a scoring system based on injury morphology, neurological status, and integrity of the thoracolumbar posterior ligament complex has been introduced to guide treatment decisions in adults >17 years of age [26].
Suspected Spine Trauma Child PCAs. The advantage of these risk factors is that they were based on a pediatric population and demonstrated 98% sensitivity. However, these risk factors have not yet been prospectively validated in a pediatric population. We decided to use the PECARN age <16 years to frame the variants in this document. There has only been one study evaluating predictors of cervical spine injury in blunt trauma in patients <3 years of age [19]. The study used a large cohort and a retrospective study design and there were no subsequent validation studies [19] (see Appendix 1). Several congenital disorders have been associated with a higher risk for cervical injury in athletes. For example, increased ligamentous laxity in patients with Down syndrome is associated with higher rates of spinal cord injury; patients with achondroplasia and spinal stenosis are at risk for significant spinal cord injury at the cervicomedullary junction with hyperflexion and hyperextension; similar injury risks related to atlantoaxial instability probably apply in patients with mucopolysaccharidosis type VI and Marfan syndrome [20]. In addition, children receiving systemic glucosteroid therapy for inflammatory diseases, such as juvenile dermatomyositis, juvenile idiopathic arthritis, systemic lupus erythematosus, systemic arthritis, and systemic vasculitis, are at higher risk for vertebral body fractures [21,22]. Children may have cartilaginous injuries that are not visualized on radiographs but are better detected with MRI [24]. In adults, MRI is the modality of choice to evaluate thoracolumbar trauma patients with neurologic deficits, abnormal CT scans, and high clinical suspicion despite negative radiographic evaluation [25]. Recently, a scoring system based on injury morphology, neurological status, and integrity of the thoracolumbar posterior ligament complex has been introduced to guide treatment decisions in adults >17 years of age [26].