Predictive Factors for Cervical Spine Fracture in Patients with Traumatic Neck Injury and mild traumatic brain injury: The “C-SPINE Fx score”
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Abstract
BACKGROUND: Cervical spine fractures are critical injuries that may lead to permanent neurological deficits if not promptly identified and treated. In resource-limited settings, clinical prediction models can support early screening and reduce unnecessary imaging.
OBJECTIVE: To develop and internally validate a clinical prediction model for identifying cervical spine fractures among patients with mild traumatic brain injury and cervical spine injury using routine clinical data from the emergency department.
METHODS: A retrospective study was conducted at Chiangrai Prachanukroh Hospital from January 2021 to December 2023, including 342 patients who underwent computed tomography (CT) of the cervical spine. Among them, 95 (27.8%) had cervical spine fractures, while 247 (72.2%) did not have fractures. Multivariable logistic regression was used to identify significant predictors. Model performance was assessed using the area under the receiver operating characteristic curve (AuROC), calibration plots, internal validation with bootstrap resampling, and decision curve analysis. An application named
“C-SPINE Fx score” was developed to predict the probability of cervical spine fracture.
RESULTS: Seven predictors were identified: neck pain (adjusted odds ratio [aOR] 1.90; p=0.031), paralysis (aOR 5.44; p<0.001), cervical spine tenderness (aOR 1.31; p=0.462), inability to move the cervical spine
(aOR 2.66; p=0.003), Glasgow Coma Scale (GCS) = 15 (aOR 1.40; p=0.398), fall from height (aOR 1.79; p=0.936), and intoxication (e.g., alcohol) (aOR 1.82; p=0.053). The model demonstrated an AuROC of 0.727
(95%CI: 0.667–0.787). Internal validation using bootstrap resampling yielded an AuROC of 0.704 (95%CI: 0.646–0.768) with a bootstrap shrinkage factor of 0.865. At the optimal probability cut-point of 19.37%, the model achieved a sensitivity of 87.4% and a false-negative rate of 3.5%.
CONCLUSIONS AND RECOMMENDATIONS: The C-SPINE Fx score model can effectively serve as a preliminary screening tool for cervical spine fractures, particularly in healthcare settings with limited resources. However, further external validation in diverse populations is recommended to confirm its generalizability and clinical utility.
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