All Publications

  • Defining pediatric cervical spine clearance with computed tomography: A prospective observational study by the Western Pediatric Surgery Research Consortium and Western Trauma Association. The journal of trauma and acute care surgery Russell, K. W., Kahan, A. M., Eldredge, R. S., Larsen, K. E., Swendiman, R. A., Rampton, J. W., Kastenberg, Z. J., Wan, H. Y., Padilla, B. E., Ostlie, D. J., Jensen, A. R., Ignacio, R. C., Chao, S. D., Kelley-Quon, L. I., Gillory, L. A., Notrica, D. M., Schroeppel, T. J., Escobar, M. A., Leneweaver, K. J., Williams, R. F., Kotagal, M., Yorkgitis, B. K., Iyer, R. R., Brockmeyer, D. L., Ravindra, V. M., Inaba, K. 2026

    Abstract

    The optimal imaging strategy for pediatric cervical spine clearance remains controversial. The primary objective of this study was to determine the sensitivity of computed tomography (CT) in detecting clinically significant cervical spine injury in children. We hypothesized that CT is sufficiently sensitive to allow for definitive clearance of the pediatric cervical spine after blunt trauma.We conducted a prospective, multicenter, observational study from March 1, 2022, to July 31, 2025, at 72 diverse adult, mixed, and pediatric trauma centers across the United States. All children <18 years who underwent cervical spine imaging after blunt trauma were included. The primary outcome was the ability of CT to identify a clinically significant cervical spine injury requiring operative intervention or halo placement. We performed a post hoc panel review of all cases with normal imaging that required surgery. The diagnostic test characteristics and 95% CI of CT were calculated.We prospectively enrolled 19,651 pediatric patients, of whom 12,693 (65%) underwent cervical spine CT and comprise the analytic cohort. The median age was 12 (interquartile range, 6-15), 37% (n=4,673) were female, and 19% (n=2,389) were obtunded, defined as GCS ≤13. The sensitivity of CT at the treating hospitals to identify a clinically significant injury was 94.7% [CI: 89.4%-97.5%], with a negative predictive value of 99.9% [CI: 99.9%-100%]. Error analysis identified eight patients with false-negative CT interpretations, of which six injuries were identifiable on retrospective review. Accounting for retrospectively identifiable injuries, CT sensitivity for detecting clinically significant injury was 98.7% [CI: 94.8%-99.8%], with a negative predictive value of 100% [CI: 99.9%-100%].In pediatric blunt trauma patients evaluated for cervical spine injury, CT is highly sensitive for detecting clinically significant injuries. These findings support pediatric cervical spine clearance based on a normal cervical spine CT. (J Trauma Acute Care Surg. 2026;00: 000-000. © 2026 The Author(s). Published by Wolters Kluwer Health, LLC. on behalf of the American Association for the Surgery of Trauma.).Prospective Cohort Study; Level II.

    View details for DOI 10.1097/TA.0000000000005120

    View details for PubMedID 42611682

  • Beyond Physical Injury: Routine Screening for Acute Stress Disorder and Posttraumatic Stress Disorder in Pediatric Trauma Patients - A Longitudinal Cohort Pilot Study. Journal of pediatric surgery Liang, N. E., Alvarez, K., Dalusag, K., Chan, K., Bunnell, B., Stroud, M., Steele, K., Chao, S. D. 2024: 161982

    Abstract

    Early identification of children at risk for PTSD is critical for improving mental health outcomes after traumatic injury. Currently, there is no standard PTSD screen for pediatric trauma patients and limited data on long-term quality of life for those who screen positive.In 2022, we piloted a comprehensive routine screening program for ASD and PTSD at our Level I PTC. All admitted trauma patients ≥8 years old were eligible for screening. Inpatients were administered the ASC3. Those who screened positive were referred for follow-up and repeat mental health evaluation. PTSD screening (CTSQ, CPSS) and quality-of-life screening (PedsQL™) surveys were administered to eligible discharged trauma patients at 1-month post-injury. Children who screened positive on the CTSQ or CPSS were referred for behavioral health services.205 children were screened for ASD using the ASC3. 49/205 children (23.9 %) had a positive screen (score ≥3). 56 children completed PTSD screening at 1-month post-discharge. 14/54 children (25.9 %) screened positive on CTSQ, and 8/50 children (16 %) screened positive on CPSS. There was a significant positive correlation between CTSQ and CPSS scores (r 0.76, ∗P<0.0001). When stratified by screening results, patients who screened positive on CTSQ and CPSS were found to have the most significant correlations with poor School and Emotional Functioning on their quality-of-life inventory.Early screening for ASD may be predictive of later development of PTSD in children. Screening using previously validated tools (ASC3, CTSQ, CPSS) were effective in identifying children with negative emotional functioning lasting beyond the acute phase of physical recovery following injury. CTSQ and CPSS both performed well for screening at one-month post-discharge. Early identification can facilitate timely referral to mental health services to potentially minimize long-term socioemotional impact of PTSD.

    View details for DOI 10.1016/j.jpedsurg.2024.161982

    View details for PubMedID 39384491