Citations 2
Plain Radiograph Use in Pediatric Blunt Trauma Patients with Suspicion for Cervical Spine Injury: A Prospective Observational Analysis of the Western Pediatric Cervical Spine Study
Kahan, Anastasia M , Eldredge, R Scott, Larsen, Kezlyn, Swendiman, Robert A. , Ravindra, Vijay M. , Russell, Katie W, group, Western Pediatric Cervical Spine Study, Kahan, Anastasia Morgan , Wan, Hsuan‐Yu , Eldredge, R Scott , Kastenberg, Zachary J. , Wallace, Marshall W. , Russell, Katie W.
Journal of the American College of Surgeons | August 7, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
Background: Despite guideline support for plain radiography (XR) in low-risk pediatric blunt trauma, CT remains the predominant imaging modality for cervical spine evaluation, increasing radiation exposure. We evaluated contemporary XR utilization and its diagnostic performance in children meeting consensus criteria for XR-first imaging. Study Design: We performed a prospective, multicenter observational study of 19,995 children enrolled in the Western Pediatric Cervical Spine Study across 72 U.S. trauma centers (2022–2025). Children appropriate for XR screening (Glasgow Coma Scale score >13, asymptomatic, non-obtunded) were identified using consensus criteria. XR utilization, sensitivity, and negative predictive value (NPV) were assessed, and multivariable logistic regression identified predictors of XR use. Results: XR was performed in 39% of patients overall and varied significantly by trauma center type (pediatric 48% vs adult 14% vs mixed 15%; p<0.001), whereas CT was used in 60%. Among XR-appropriate children (n=12,650), an estimated 7,705 CT examinations could potentially have been replaced with XR. In the overall cohort, XR sensitivity for any cervical spine injury was 30.3% (95% CI 26.2–34.6%) with an NPV of 95.2% (95% CI 94.7–95.7%). In XR-appropriate children, only two clinically significant cervical spine injuries were missed, yielding a sensitivity of 75.0% (95% CI 34.9–96.8%) and an NPV of 99.9% (95% CI 99.9%–100.0%). Conclusions: Plain radiography is substantially underutilized in children meeting consensus criteria for XR-first imaging. In appropriately selected patients, XR demonstrated an NPV of 99.9% for clinically significant cervical spine injury, supporting broader implementation of XR-first imaging strategies to reduce CT utilization and pediatric radiation exposure.
Survival outcomes in pediatric patients with metastatic Ewing sarcoma who achieve a rapid complete response of pulmonary metastases
Reiter, Audra J. , Huang, Lynn , Craig, Brian T. , Davidoff, Andrew M. , Coggins, Jordan , Smith, Jasmine , Aldrink, Jennifer H. , Bergus, Katherine , MacArthur, Taleen A. , Polites, Stephanie F. , Boehmer, Chloé , Brungardt, Joseph G. , Arkin, Cameron, Gourmel, Antoine , Piché, Nelson , Wallace, Marshall, Liang, Jiancong , Lovvorn, Harold N. , Petroze, Robin T. , Gillies, Gwendolyn S. , Marquart, John , Becktell, Kerri , Favela, Juan , Rich, Barrie S. , Glick, Richard D. , Seemann, Natashia M. , Davidson, Jacob , Wilson, Claire A. , Roach, Jonathan P. , Doyle, Kathleen , Coakley, Brian A. , Emengo, Pamela, Merola, Pamela R., Grant, Christa N. , Tirumani, Anuritha, Dasgupta, Roshni , Wallace, Marshall W. , Aldrink, Jennifer H , Bergus, Katherine C , MacArthur, Taleen A , Malek, Marcus M , Kastenberg, Zachary J , Piche, Nelson , Becktell, Kerri , Seemann, Natashia M , Tracy, Elisabeth T , Lautz, Timothy , Dasgupta, Roshni , Arkin, Cameron , Talbot, Lindsay J , Malek, Marcus M. , Rinehardt, Hannah , Kastenberg, Zachary J. , Wallace, Marshall, Le, Hau D. , Brown, Erin G. , Tracy, Elisabeth T. , Moya‐Mendez, Mary E. , Lautz, Timothy B.
Pediatric Blood & Cancer | April 29, 2024 | Volume: 71 | Issue: 7 | Pages: No page available
Abstract Purpose Our objectives were to compare overall survival (OS) and pulmonary relapse between patients with metastatic Ewing sarcoma (EWS) at diagnosis who achieve rapid complete response (RCR) and those with residual pulmonary nodules after induction chemotherapy (non‐RCR). Patients and methods This retrospective cohort study included children under 20 years with metastatic EWS treated from 2007 to 2020 at 19 institutions in the Pediatric Surgical Oncology Research Collaborative. Chi‐square tests were conducted for differences among groups. Kaplan–Meier curves were generated for OS and pulmonary relapse. Results Among 148 patients with metastatic EWS at diagnosis, 61 (41.2%) achieved RCR. Five‐year OS was 71.2% for patients who achieved RCR, and 50.2% for those without RCR ( p = .04), and in multivariable regression among patients with isolated pulmonary metastases, RCR (hazards ratio [HR] 0.42; 95% confidence interval [CI]: 0.17–0.99) and whole lung irradiation (WLI) (HR 0.35; 95% CI: 0.16–0.77) were associated with improved survival. Pulmonary relapse occurred in 57 (37%) patients, including 18 (29%) in the RCR and 36 (41%) in the non‐RCR groups ( p = .14). Five‐year pulmonary relapse rates did not significantly differ based on RCR (33.0%) versus non‐RCR (47.0%, p = .13), or WLI (38.8%) versus no WLI (46.0%, p = .32). Discussion Patients with EWS who had isolated pulmonary metastases at diagnosis had improved OS if they achieved RCR and received WLI, despite having no significant differences in rates of pulmonary relapse.