儿童颈椎下轴损伤分类评分的验证:一家一级儿科创伤中心的单一机构经验。

IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Journal of neurosurgery. Pediatrics Pub Date : 2024-07-05 Print Date: 2024-10-01 DOI:10.3171/2024.4.PEDS24102
Martin G Piazza, Vijay M Ravindra, Emma R Earl, Allison Ludwick, Gabriela Sarriera Valentin, Andrew T Dailey, John R W Kestle, Katie W Russell, Douglas L Brockmeyer, Rajiv R Iyer
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引用次数: 0

摘要

目的:颈椎轴下损伤分类(SLIC)评分此前尚未在儿科人群中得到验证。作者将 SLIC 对小儿颈椎轴下损伤的治疗建议与现实世界中的小儿脊柱手术实践进行了比较:一项回顾性队列研究在儿科一级创伤中心进行,对象是 2012 年至 2021 年期间接受创伤评估的年龄小于 18 岁的患者。为每位患者计算 SLIC 分数,并将随后的建议与实际治疗进行比较。计算了误诊百分比、灵敏度、特异性、阳性预测值(PPV)和阴性预测值(NPV)以及接收者操作特征曲线(ROC)下面积(AUC):共纳入 243 名儿童创伤患者。25名患者(10.3%)接受了手术治疗,218名患者接受了保守治疗。SLIC评分的中位数为2(四分位距=2)。16名患者(6.6%)的SLIC评分为4分,建议保守治疗或手术治疗;27名儿童的SLIC评分≥5分,建议手术治疗;200名儿童的SLIC评分≤3分,建议保守治疗。在 243 名患者中,227 名接受了与 SLIC 评分建议一致的治疗(P < 0.001)。SLIC 在确定手术治疗患者方面的灵敏度为 79.2%,在准确确定接受保守治疗患者方面的特异度为 96.1%。PPV为70.3%,NPV为97.5%。使用 SLIC 时的误诊率为 5.7%(n = 13)。在 SLIC 建议手术治疗的患者中,29.6%(n = 8)的患者没有接受手术治疗;同样,在 SLIC 建议保守治疗的患者中,2.5%(n = 5)的患者接受了手术治疗。确定接受治疗的 ROC 曲线显示出极佳的判别能力,AUC 为 0.96(OR 3.12,P < 0.001)。按年龄(小于 10 岁和≥ 10 岁)划分队列时,灵敏度分别降至 0.5 和 0.82;特异性仍然很高,分别为 0.98 和 0.94:SLIC评分系统对儿童外伤性颈椎椎体下损伤的建议治疗与实际治疗相似,误判率低,特异性高达96%。这些研究结果表明,SLIC 可用于指导颈椎轴下损伤儿童患者的治疗。有必要通过多中心队列对该评分在幼儿(小于 10 岁)中的应用进行进一步研究。
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Validation of the Subaxial Cervical Spine Injury Classification score in children: a single-institution experience at a level 1 pediatric trauma center.

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.

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来源期刊
Journal of neurosurgery. Pediatrics
Journal of neurosurgery. Pediatrics 医学-临床神经学
CiteScore
3.40
自引率
10.50%
发文量
307
审稿时长
2 months
期刊介绍: Information not localiced
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