Table 2

Papers dealing with radiology of the paediatric c-spine in trauma

Author, date, countryPatient groupStudy typeResultsWeaknesses
Viccelio et al, 2001, USA (NEXUS)3065 patients aged <18 years in 21 centres undergoing radiography for blunt trauma.Prospective, observational study of a decision instrument of whether or not to undertake radiography.30 spinal cord injuries. Instrument sensitivity 100% (CI 87.8 to 100.0%).Small number of injured patients.
Lally et al, 1989, USA187 children who had c-spine radiographs: all fractures over a 20 year period plus all attendances over a 2.5 year periodRetrospective, blinded review of radiographs and review of notes.16 radiological abnormalities. No injury below C4 in under 8s.Small numbers.
Age of “child” not defined.
Retrospective.
Rachesky et al, 1987, USA2133 children <18 years with c-spine radiographs for “trauma related event” over a seven year period.Retrospective notes and radiological review.25 radiological abnormalities. Combination of history of neck pain and vehicular accident with trauma would have identified all fractures.Retrospective
Not blinded.
All initially “normal” radiographs not reviewed.
Jaffe et al, 1987, USA206 children 16 years or less: all children with c-spine radiographs over one year period plus all children with proven or suspected c-spine injury over a 10 year period.Retrospective review of notes and radiographs59 c-spine injuries, 1 SCIWORA.Retrospective.
Some outcome data.Not blinded.
Eight variables identified as criteria for undertaking radiography.27 patients excluded for missing data.
Does not state how outcome data were obtained, or length of follow up.
Keiper et al, 1998, USA52 children with history of c-spine trauma in whom 3-view c-spine plain films and CT demonstrated no fracture.Retrospective review of MRIs, CTs and plain films by three neuroradiologists. Clinical follow up.16 positive MRIs.Retrospective.
36 patients with negative MRIs were all followed up with no neurological sequelae.Not blinded.