Thoracolumbar Injury Classification and Severity Score in children: a reliability study

2018 ◽  
Vol 21 (3) ◽  
pp. 284-291 ◽  
Author(s):  
Ross L. Dawkins ◽  
Joseph H. Miller ◽  
Omar I. Ramadan ◽  
Michael C. Lysek ◽  
Elizabeth N. Kuhn ◽  
...  
Keyword(s):  
Severity Score ◽  
Interrater Reliability ◽  
Pediatric Patients ◽  
Motor Vehicle ◽  
Classification Systems ◽  
Actual Treatment ◽  
Vehicle Accidents ◽  
Thoracolumbar Injury ◽  
The Mean ◽  
Injury Classification

OBJECTIVEThere are many classification systems for injuries of the thoracolumbar spine. The recent Thoracolumbar Injury Classification and Severity Score (TLICS) has been shown to be a reliable tool for adult patients. The aim of this study was to assess the reliability of the TLICS system in pediatric patients. The validity of the TLICS system is assessed in a companion paper.METHODSThe medical records of pediatric patients with acute, traumatic thoracolumbar fractures at a single Level 1 trauma center were retrospectively reviewed. A TLICS was calculated for each patient using CT and MRI, along with the neurological examination recorded in the patient’s medical record. TLICSs were compared with the type of treatment received. Five raters scored all patients separately to assess interrater reliability.RESULTSTLICS calculations were completed for 81 patients. The mean patient age was 10.9 years. Girls represented 51.8% of the study population, and 80% of the study patients were white. The most common mechanisms of injury were motor vehicle accidents (60.5%), falls (17.3%), and all-terrain vehicle accidents (8.6%). The mean TLICS was 3.7 ± 2.8. Surgery was the treatment of choice for 33.3% of patients. The agreement between the TLICS-suggested treatment and the actual treatment received was statistically significant (p < 0.0001). The interrater reliability of the TLICS system ranged from moderate to very good, with a Fleiss’ generalized kappa (κ) value of 0.69 for the TLICS treatment suggestion among all patients; however, interrater reliability decreased when MRI was used to contribute to the TLICS. The κ value decreased from 0.73 to 0.57 for patients with CT only vs patients with CT/MRI or MRI only, respectively (p < 0.0001). Furthermore, the agreement between suggested treatment and actual treatment was worse when MRI was used as part of injury assessment.CONCLUSIONSThe TLICS system demonstrates good interrater reliability among physicians assessing thoracolumbar fracture treatment in pediatric patients. Physicians should be cautious when using MRI to aid in the surgical decision-making process.

scholarly journals Stability of the Subaxial Spine after Penetrating Trauma: Do Classification Systems Apply?

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Jackson Rucker Staggers ◽  
Thomas Elliot Niemeier ◽  
William E. Neway ◽  
Steven Michael Theiss
Keyword(s):  
Severity Score ◽  
Penetrating Trauma ◽  
Adverse Outcomes ◽  
Classification Systems ◽  
Neurological Deficits ◽  
Spine Injury ◽  
Spinal Instability ◽  
Equal Distribution ◽  
Thoracolumbar Injury ◽  
Injury Classification

Objective. Blunt spinal trauma classification systems are well established and provide reliable treatment algorithms. To date, stability of the spine after civilian gunshot wounds (CGSWS) is poorly understood. Herein, we investigate the validity of trauma classification systems including the Thoracolumbar Injury Classification and Severity Score (TLICS), Subaxial Cervical Spine Injury Classification and Severity Score (SLIC), and Denis’ three-column model when applied to spinal penetrating trauma from gunshots, while secondarily evaluating stability of these injuries. Methods. Gunshot injuries to the spine were identified from an institutional database from ICD-nine codes. Trauma scorings systems were applied using traditional criteria. Neurologic compromise and spinal stability were evaluated using follow-up clinic notes and radiographs. Results. Thirty-one patients with CSGSW were evaluated. There was an equal distribution of injuries amongst the spinal levels and spinal columns. Twenty patients had neurological deficits at presentation. Eight patient had a TLICS score >4. Three patients had a SLIC score >4. One patient had surgical treatment. Nonoperative treatment did not lead to spinal instability or adverse outcomes in any cases. The posterior column had a high correlation with neurologic compromise, though not statistically significant (p=.118). Conclusions. The TLICS, SLIC, and three-column classification systems cannot be applied to CSGSW to quantify injury severity, predict outcomes, or guide treatment decision-making. Despite significant neurologic injuries and disruption of multiple spinal columns, CSGSW do not appear to result in unstable injuries requiring operative intervention. Further research is needed to identify the rare spinal gunshot injury that would benefit from immediate surgical intervention.

Thoracolumbar spine trauma classification: the Thoracolumbar Injury Classification and Severity Score system and case examples

2009 ◽  
Vol 10 (3) ◽  
pp. 201-206 ◽  
Author(s):  
Alpesh A. Patel ◽  
Andrew Dailey ◽  
Darrel S. Brodke ◽  
Michael Daubs ◽  
James Harrop ◽  
...  
Keyword(s):  
Severity Score ◽  
Injury Severity ◽  
Thoracolumbar Spine ◽  
Neurological Status ◽  
Classification Systems ◽  
Spine Trauma ◽  
Injury Characteristics ◽  
Severity Of Injury ◽  
Thoracolumbar Injury ◽  
Injury Classification

Object The aim of this study was to review the Thoracolumbar Injury Classification and Severity Score (TLICS) and to demonstrate its application through a series of spine trauma cases. Methods The Spine Trauma Study Group collaborated to create and report the TLICS system. The TLICS system is reviewed and applied to 3 cases of thoracolumbar spine trauma. Results The TLICS system identifies 3 major injury characteristics to describe thoracolumbar spine injuries: injury morphology, posterior ligamentous complex integrity, and neurological status. In addition, minor injury characteristics such as injury level, confounding variables (such as ankylosing spondylitis), multiple injuries, and chest wall injuries are also identified. Each major characteristic is assigned a numerical score, weighted by severity of injury, which is then summated to yield the injury severity score. The TLICS system has demonstrated initial success and its use is increasing. Limitations of the TLICS system exist and, in some instances, have yet to be addressed. Despite these limitations, the severity score may provide a basis to judge spinal stability and the need for surgical intervention. Conclusions By addressing both the posterior ligamentous integrity and the patient's neurological status, the TLICS system attempts to overcome the limitations of prior thoracolumbar classification systems. The TLICS system has demonstrated both validity and reliability and has also been shown to be readily learned and incorporated into clinical practice.

scholarly journals Radiographic Parameters in Diagnosis of Posterior Ligamentous Complex Injury

2020 ◽  
Vol 6 (3) ◽  
pp. 133-142
Author(s):  
Shahrokh Yousefzadeh-Chabok ◽  
◽  
Zoheir Reihanian ◽  
Zoheir Reihanian ◽  
Amin Naseri ◽  
...  
Keyword(s):  
Body Height ◽  
Thoracolumbar Spine ◽  
Classification Systems ◽  
Detection Methods ◽  
Imaging Method ◽  
Radiographic Parameters ◽  
Posterior Ligament Complex ◽  
Thoracolumbar Injury ◽  
The Mean ◽  
Injury Classification

Background and Aim: Diagnosing the status of the posterior ligament complex (PLC) plays an essential role in the management of patients with thoracolumbar fractures. In this study, due to the inefficiency of existing imaging modalities in the accurate detection of PLC damage, we investigated the relevance of some imaging parameters to specific guidelines for rapid PLC injury detection. Methods and Materials/Patients: In this study, 50 patients with and 50 patients without PLC injury were included. MRI, CT scan, and radiographic imaging of the thoracolumbar spine (T12-L1) were evaluated. The thoracolumbar injury classification systems such as Denis, TLICS (Thoracolumbar Injury Classification and Scoring System), and McCormack Load Sharing and radiographic parameters such as Superior Inferior Endplate Angle (SIEA), Body Height (BH), Local Kyphosis (LK), Interspinous Distance (ISD), and Interpedicular Distance (IPD) were investigated in these patients for each imaging method. Statistical analysis was performed using SPSS (Version 21). Result: The ISD and LK and BHp (Body Height Posterior) were significant predictors of PLC injury. On radiographs, the mean LK with and without PLC damage was 25.67° and 20.92°, respectively (p<0.001). The ISD difference was 6.75 mm in cases with PLC damage and 2.84 mm in cases with an intact PLC (p<0.0001). In CT images, the mean LK was 25.77° in cases with PLC damage and 18.63° in cases with an intact PLC (p<0.037). The ISD difference was 4.14 mm in patients with PLC damage and 2.19 mm in patients without PLC damage (p<0.002). The BHp difference was 9.44 mm in cases with PLC damage and 11.09 mm in cases without PLC damage (p<0.002). Conclusion: The current study suggests formulating a predictive radiological index to identify PLC injury successfully. These guidelines can be very helpful in emergency room decision-makings, especially when the cost, availability, and time of performing MRI are important concerns in patients with multiple trauma.

scholarly journals TEVAR versus open repair of blunt traumatic descending aortic injury in polytraumatic patients involved in motor vehicle accidents

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Imthiaz Manoly ◽  
Mohamed El Tahan ◽  
Maymoona Al Shuaibi ◽  
Fatimah Adel ◽  
Mohammed Al Harbi ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Hospital Stay ◽  
Open Repair ◽  
Motor Vehicle ◽  
Aortic Injury ◽  
Motor Vehicle Accidents ◽  
Time Interval ◽  
Vehicle Accidents ◽  
Severity Scores ◽  
The Mean

Abstract Background Thoracic endovascular aortic repair (TEVAR) is the standard-of-care for treating traumatic aortic injury (TAI). Few retrospective studies compared TEVAR to open repair in blunt traumatic aortic injury (BTAI). Our objectives were to compare the early outcomes of TEVAR for blunt traumatic descending aortic injury to open repair (OR) in polytraumatic patients involved in motor vehicle accidents (MVA). Results Between February 2005 and April 2017, 71 patients with TAI due to MVA presented to our institution. All patients with descending aortic injuries were considered for open repair (n = 41) or TEVAR (n = 30) if there was no contraindication. The primary outcome was mortality, and secondary outcomes were stroke, paraplegia, intensive care unit (ICU), and hospital stay. The mean age was 28.4 ± 10.1 years in the OR group and 33.3 ± 16.6 years in TEVAR-group (P = 0.13). The injury severity scores were 41 ± 10 in the OR group and 33 ± 17 in the TEVAR group (P = 0.03). Patients in the OR group underwent emergency repair with a mean time of 0.56 ± 0.18 days from arrival. The TEVAR group had a longer time interval between arrival and procedure (2.1 ± 1.7 days, P = 0.001). The OR group had more blood transfusion (24 (58.5%) vs. 8 (27.5%), P = 0.002), renal impairment (6 (14.6%) vs. 1 (5.50%), P = 0.23), and wound infection (21 (51.2%) vs. 3 (10%), P < 0.001). Three TEVAR patients had a perioperative stroke compared to two patients in the OR group (P = 0.64). There was no difference in the mean ICU (6 ± 8.9 vs. 5.3 ± 2.9 days; P = 0.1) or hospital stay (20.1 ± 12.3 vs. 20.1 ± 18.3, P = 0.62) between the two groups. There were four deaths in the OR group and none in the TEVAR group (P = 0.13). Conclusion The results of TEVAR were comparable with the open repair for traumatic aortic injury with good early postoperative outcomes. TEVAR repair could be associated with lower mortality, blood transfusion, and infective complications. However, the complexity of the injury and technical challenges were higher in the open group.

Retroclival Epidural Hematomas

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 404-407 ◽  
Author(s):  
R. Shane Tubbs ◽  
Christoph J. Griessenauer ◽  
Todd Hankinson ◽  
Curtis Rozzelle ◽  
John C. Wellons ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Pediatric Patients ◽  
Motor Vehicle ◽  
Coma Scale ◽  
Presenting Symptoms ◽  
Cord Injury ◽  
The Mean

Abstract BACKGROUND Retroclival epidural hematomas (REDHs) are infrequently reported. To our knowledge, only 19 case reports exist in the literature. OBJECTIVE This study was performed to better elucidate this pathology. METHODS We prospectively collected data for all pediatric patients diagnosed with REDH from July 2006 through June 2009. Data included mechanism of injury, Glasgow Coma Scale score, neurological examination, treatment modality, and outcome. Magnetic resonance imaging was used to measure REDH dimensions. RESULTS Eight children were diagnosed with REDH, and the hematomas were secondary to motor vehicle–related trauma in all cases. The mean age of patients was 12 years (range 4–17 years). The mean REDH height (craniocaudal) was 4.0 cm, and the mean thickness (dorsoventral) was 1.0 cm. At presentation, the mean Glasgow Coma Scale score was 8 (range 3–14), and there was no correlation between hematoma size and presenting symptoms. Two patients died soon after injury, and 2 additional patients had atlanto-occipital dislocation that required surgical intervention. No patient underwent surgical evacuation of the REDH. The mean follow-up was 14 months. At most recent follow-up, 4 patients are neurologically intact, 1 patient has a complete spinal cord injury, and 1 patient has mild bilateral abducens nerve palsy. CONCLUSION To our knowledge, this study of 8 pediatric patients is the largest series of patients with REDH thus far reported. Based on our study, we found that REDH is likely to be underdiagnosed, atlanto-occipital dislocation should be considered in all cases of REDH, and many patients with REDH will have minimal long-term neurological injury.

scholarly journals Subaxial cervical spine trauma classification: the Subaxial Injury Classification system and case examples

2008 ◽  
Vol 25 (5) ◽  
pp. E8 ◽  
Author(s):  
Alpesh A. Patel ◽  
Andrew Dailey ◽  
Darrel S. Brodke ◽  
Michael Daubs ◽  
Paul A. Anderson ◽  
...  
Keyword(s):  
Classification System ◽  
Severity Score ◽  
Injury Severity ◽  
Neurological Status ◽  
Classification Systems ◽  
Spine Trauma ◽  
Prognostic Information ◽  
Cervical Trauma ◽  
Injury Characteristics ◽  
Injury Classification

Object The authors review a novel subaxial cervical trauma classification system and demonstrate its application through a series of cervical trauma cases. Methods The Spine Trauma Study Group collaborated to create the Subaxial Injury Classification (SLIC) and Severity score. The SLIC system is reviewed and is applied to 3 cases of subaxial cervical trauma. Results The SLIC system identifies 3 major injury characteristics to describe subaxial cervical injuries: injury morphology, discoligamentous complex integrity, and neurological status. Minor injury characteristics include injury level and osseous fractures. Each major characteristic is assigned a numerical score based upon injury severity. The sum of these scores constitutes the injury severity score. Conclusions By addressing both discoligamentous integrity and neurological status, the SLIC system may overcome major limitations of earlier classification systems. The system incorporates a number of critical clinical variables—including neurological status, absent in earlier systems—and is simple to apply and may provide both diagnostic and prognostic information.

scholarly journals The Need for Three Separate Parallel WAD Ratings of Whiplash Injuries to Cervical, Lumbosacral, and Thoracic Spine in Clinical Assessments of Injured Motorists

2021 ◽  
Vol 3 (1) ◽  
pp. 154-159
Author(s):  
Zack Z. Cernovsky ◽  
Stephan C. Mann ◽  
Varadaraj R. Velamoor ◽  
L. Kola Oyewumi
Keyword(s):  
Thoracic Spine ◽  
Motor Vehicle ◽  
Classification Systems ◽  
Lumbosacral Spine ◽  
Vehicle Accidents ◽  
Lower Back ◽  
Neuropsychological Symptoms ◽  
Whiplash Associated Disorder ◽  
Moderate Magnitude

Background: The prevailing classification of whiplash associated disorder (WAD) focuses solely on neck injuries, thus implying that injuries to other spinal regions are relatively inconsequential. In fact, some whiplash studies exclude patients with injuries to lower spine. We examined whiplash pain locations of injured motorists and their statistical correlates. Method: De-identified archival data of 158 injured motorists (57 men and 101 women; mean age 39.4 years, SD=12.5) were reviewed statistically. Their motor vehicle accidents (MVAs) occurred 7 to 194 weeks previously (mean=50.7 weeks, SD=38.5), but all still experienced active whiplash symptoms requiring therapy. Results: The most frequently reported locations of whiplash pain were the head (89.9%), neck (88.6%), shoulders (80.4%), and lower back (77.8%). WAD studies that exclude patients with lower back pain might exclude about 82.9% of injured motorists: the remaining 17.1% of patients with whiplash injury only to the neck are presumably those less adversely affected by the MVA than patients with pain in multiple locations. No correlations of high or moderate magnitude were detected among the various pain locations. Furthermore, no high or moderate correlations were observed between clinical variables (including 2 neuropsychological symptoms scales) and reports of headache or pain in the neck or in lower back. Discussion and Conclusions: The prevailing WAD classification system needs to be renamed as specific to neck injury only: WAD-C. Parallel WAD classification systems need to be introduced separately for the lumbosacral spine (as WAD-LS) as well as the thoracic spine (as WAD-T) to improve diagnostic descriptive precision of clinical WAD assessments and of their research applications.

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