The Thoracolumbar Injury Classification and Severity Score Appropriately Predicts Treatment in Children Aged 10 and Under

Study Design. Retrospective cohort study. Objective. This study aims to assess the validity of the Thoracolumbar Injury Classification and Severity Score (TLICS) in patients ≤10 years-old. Summary of Background Data. TLICS is a validated measure developed to help facilitate clinical decision-making regarding thoracolumbar spinal trauma in adults. Studies examining the utility of TLICS in children skew towards older pediatric patients, where the spine’s biomechanical properties are more similar to adults. Due to differences in a pre-adolescent spine compared to a more mature, adolescent spine, it is unclear if TLICS can be applied to younger patients. Methods. A single center spine trauma registry was queried for patients ≤10 with an acute, traumatic thoracolumbar fracture treated at a level-1 pediatric trauma center between 2006 and 2020. Test characteristics and Receiver-Operator Curve were used to evaluate TLICS based on TLICS <4=nonsurgical treatment and TLICS >4=surgery recommendation. Results. We identified 94 patients with traumatic thoracolumbar fractures (surgical=20; non-surgical=74). Despite TLICS-suggested operative management in 28 patients with TLICS>4, 9 (32.1%) were initially treated non-operatively. All patients who deviated from TLICS-suggested treatment had flexion-distraction injuries (FDI). Sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 89.2%, 70.4%, and 100%, respectively. The receiver operating characteristic curve demonstrated strong diagnostic ability of TLICS in predicting need for surgery (area under the curve: 0.97, F1-score: 0.86). Conclusion. TLICS score <4 showed strong validity and is highly specific in predicting non-operative management for patients ≤10 years-old with thoracolumbar fractures. However, TLICS >4 has more limited specificity in indicating the necessity for surgical intervention, as many FDIs were successfully treated without surgery. Additional factors other than TLICS score may need to be considered for these more severe injuries to optimize management in this age group.