Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. The Cochrane Back and Neck Group have produced approximately 100 Cochrane reviews, covering the effects of interventions and the accuracy of diagnostic tests. One of these, relevant to the detection of spinal injury in children, was updated in March 2024. We asked lead author, Emma Tavender from Murdoch Children's Research Institute in Melbourne Australia to tell us about the latest findings in this podcast.

Emma: Although cervical spine injury is rare in children who experience a blunt trauma (such as being involved in a motor vehicle-related crash or falling from a height), it is important not to miss this injury because the consequences can be devastating, including death or lifelong disability.
Imaging such as computed tomography, or CT for short, magnetic resonance imaging (MRI), and X-rays can be used to identify cervical spine injuries. However, CT scans and plain X-rays use radiation and increase the risk of developing cancer, especially in children. MRI doesn’t use radiation but can require prolonged immobilisation or sedation to perform and have subsequent resource implications.
This requires a careful balance. Physicians wish to avoid exposing children at low risk for cervical spine injury to unnecessary tests and associated risks whilst still identifying all those children with cervical spine injuries.  Clinical decision rules can help in this decision-making process, several have been developed to guide the decision to order imaging in adult trauma patients with high accuracy, but little is known about their accuracy in children and there have also been more recent efforts to develop child specific rules.
We wanted to address this gap by finding out which clinical decision rules or tools were most accurate in determining which children were at risk for cervical spine injury following blunt trauma and whether imaging should be used to help diagnosis.
For this review update, we searched for studies published in 2015 to 2022 and included five studies recruiting more than 21,000 children. These five studies assessed the accuracy of seven different clinical decision rules to evaluate cervical spine injury following blunt trauma in children. Although most of these accurately identified children who had a cervical spine injury (called high sensitivity), they frequently did not correctly identify children who did not have a cervical spine injury (called low specificity). This means that if these clinical decision rules were applied as a rule, a large proportion of children without cervical spine injury attending the emergency department for a blunt trauma assessment would receive imaging potentially exposing them to unnecessary radiation. Another thing to consider is that for many of the studies with high sensitivity the number of cervical spine injuries in children was quite low therefore these high sensitivities need to be interpreted with caution.
In conclusion, therefore, we determined that there is currently insufficient evidence to determine which clinical decision rules are most effective at detecting cervical spine injury following blunt trauma in children, particularly for those under eight years of age, where evidence is especially sparse. These clinical decision rules are at best a guide to clinical assessment, and current evidence does not support their strict use in trauma care for children. More research is needed to evaluate their accuracy and we identified two large ongoing studies that should contribute to this evidence.

Mike: If you would like to learn more about the five studies that have been done and the seven tools that they assessed, the full review is available at Cochrane Library dot com with a simple search for "spine injury in children". That’s also how to watch for the next update of the review, if that additional evidence becomes available.