• Ross L Dawkins, Joseph H Miller, Sarah T Menacho, Omar I Ramadan, Michael C Lysek, Elizabeth N Kuhn, R Shane Tubbs, Marion L Walker, Beverly C Walters, Bonita S Agee, and Curtis J Rozzelle.
• Section of Pediatric Neurosurgery, Children's of Alabama, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama.
• Neurosurgery. 2019 Jun 1; 84 (6): E362-E367.

BackgroundThe Thoracolumbar Injury Classification and Severity Score (TLICS) has been shown to be a valid tool for assessing the need for surgical intervention in adult patients. There is limited insight into its usefulness in children.ObjectiveTo assess the validity of the TLICS system in pediatric patients.MethodsThe medical records for pediatric patients with acute, traumatic thoracolumbar fractures at two Level 1 trauma centers were reviewed retrospectively. A TLICS score was calculated for each patient using computed tomography and magnetic resonance images, along with the neurological examination recorded in the patient's medical record. TLICS scores were compared with the type of treatment received. Receiver operating characteristic (ROC) curve analysis was employed to quantify the validity of the TLICS scoring system.ResultsTLICS calculations were completed for 165 patients. The mean TLICS score was 2.9 (standard deviation ± 2.7). Surgery was the treatment of choice for 23% of patients. There was statistically significant agreement between the TLICS suggested treatment and the actual treatment received (P < 0.001). The ROC curve calculated using multivariate logistic regression analysis of the TLICS system's parameters as a tool for predicting treatment demonstrated excellent discriminative ability, with an area under the ROC curve of 0.96, which was also statistically significant (P < 0.001).ConclusionThe TLICS system demonstrates good validity for selecting appropriate thoracolumbar fracture treatment in pediatric patients.Copyright © 2018 by the Congress of Neurological Surgeons.

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