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, USA | 187 children who had c-spine radiographs: all fractures over a 20 year period plus all attendances over a 2.5 year period | Retrospective, 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, USA | 2133 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, USA | 206 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 radiographs | 59 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, USA | 52 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. |