Project Snapshot -Triage tools for detecting cervical spine injury

Cochrane Review – Triage tools for detecting cervical spine injury in paediatric trauma patients

Co-ordinating PI:

Emma Tavender

Study Co-ordinator: N/A
Project aim/s:

To expand the scope and update the Cochrane review ‘ Triage tools for detecting cervical spine injury in paediatric trauma patients (updated search from 2017 to 3 June 2021) to determine the diagnostic accuracy of clinical decision rules (CDRs) or sets of clinical criteria used to evaluate for cervical spine injury (CSI) following blunt trauma in a paediatric population.

Study design:

Cochrane Diagnostic Accuracy Review.

Study types:

Diagnostic studies with cross-sectional or cohort designs (retrospective or prospective) and randomised controlled trials. We only included results from full reports. We excluded case-control studies and reports that evaluated predictor finding models because of the bias they might introduce. We preferred studies that evaluated the accuracy of CDRs in direct comparisons to each other, however, we did not exclude studies with indirect comparisons as we expected the number of studies with direct comparisons to be limited.

Index test:

Any CDR or set of clinical criteria that compared the diagnostic accuracy of the test for the target condition with the reference standard.

Reference test:

Computed tomography (CT), plain radiography (X-ray) or magnetic resonance imaging (MRI). We also included studies where the cervical spine was clinically cleared in the emergency department in low risk patients at the treating clinician’s discretion. We preferred to include studies where patients who did not receive imaging underwent either a medical record review or an additional follow up some time after discharge to ensure no CSIs were missed or other systems were used to ensure initially missed CSI were diagnosed. The imaging or clinical follow up should be undertaken within 72 hours of presentation to the ED.

Target condition:

Clinically-important cervical spine injury (CSI), defined as any fracture, dislocation, ligamentous injury or spinal cord injury (either detectable by diagnostic imaging or spinal cord injury without radiographic association) involving the cervical region and attaching ligamentous structures.

Current status:

Completed, accepted and currently being copy-edited.