Injury · 2026
Development and internal validation of a risk prediction calculator for minor spinal cord injury in CT-negative blunt trauma.
СтатьяВалидационное исследованиеНазвание и аннотация: Перевод в очереди
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Berglas Eli, Bijoor Vinay R, Gelfand Yaroslav
Аннотация
BACKGROUND: Clinical calculators are used to determine which trauma patients require computed tomography (CT) scans of the spine. However, mild traumatic spinal cord injury (TSCI) may be present despite a negative CT scan. Therefore, the present study sought to internally validate the use of two calculators (whole spine and cervical-only) to identify such patients.
METHODS: The Spinal Cord Injury Model System Program was used to conduct this retrospective cohort study. Patients at least 15 years old with an American Spinal Injury Association (ASIA) grade D injury due to blunt trauma were included. Patients with and without concurrent vertebral injury were considered CT-evident and CT-occult, respectively. A Firth's regression was used to establish β coefficients, which were converted into points to predict CT-occult TSCI. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated at the optimal point threshold.
RESULTS: This study included 589 patients (mean age = 54.1 ± 16.7), of whom 182 (31%) were CT-occult. In the all-injury level calculator, ages 30-70 added three points; ages 70+ added one point; fall injuries added one point; cervical level injury added seven points; clinical suspicion of central cord syndrome (CCS) added one point, whereas the presence of associated injuries deducted three points. At the seven-point cutoff, sensitivity was 97.3%, specificity was 21.9%, PPV was 35.8%, and NPV was 94.7%. The cervical calculator assigned one point for ages 45-60, fall injuries, and CCS, but deducted two points if there were associated injuries. At the zero-point threshold, sensitivity was 96.6%, specificity was 8.5%, PPV was 36.4%, and NPV was 82.4%.
CONCLUSIONS: The calculators demonstrated high sensitivity and may be invaluable adjuncts for assessing suspected CT-negative TSCI. External validation is necessary to determine their generalizability.
METHODS: The Spinal Cord Injury Model System Program was used to conduct this retrospective cohort study. Patients at least 15 years old with an American Spinal Injury Association (ASIA) grade D injury due to blunt trauma were included. Patients with and without concurrent vertebral injury were considered CT-evident and CT-occult, respectively. A Firth's regression was used to establish β coefficients, which were converted into points to predict CT-occult TSCI. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated at the optimal point threshold.
RESULTS: This study included 589 patients (mean age = 54.1 ± 16.7), of whom 182 (31%) were CT-occult. In the all-injury level calculator, ages 30-70 added three points; ages 70+ added one point; fall injuries added one point; cervical level injury added seven points; clinical suspicion of central cord syndrome (CCS) added one point, whereas the presence of associated injuries deducted three points. At the seven-point cutoff, sensitivity was 97.3%, specificity was 21.9%, PPV was 35.8%, and NPV was 94.7%. The cervical calculator assigned one point for ages 45-60, fall injuries, and CCS, but deducted two points if there were associated injuries. At the zero-point threshold, sensitivity was 96.6%, specificity was 8.5%, PPV was 36.4%, and NPV was 82.4%.
CONCLUSIONS: The calculators demonstrated high sensitivity and may be invaluable adjuncts for assessing suspected CT-negative TSCI. External validation is necessary to determine their generalizability.