An Eight-Variable Clinical Assessment Model for the Prediction of Cervical Spine Injury in Children-Reply FREE

In Reply.—We greatly appreciate the letter by Binns and colleagues. We would concur that if our two-variable clinical assessment model missed even one child with roentgenographically proven cervical spine injuries, then the two-variable model should not be used to determine the necessity of obtaining cervical spine films. In our assessment, we did not distinguish between neck pain and neck tenderness, but after talking with Dr Jaffe we fully understand their reasoning in making this distinction; Dr Jaffe pointed out that there is an important distinction between neck pain and neck tenderness, as tenderness implies that the neck immobilization collar was removed so that tenderness might be elicited. Dr Binns informed us that of the eight patients in their series who would have been missed if our criteria had been used, four did not have documentation of pain or tenderness, one had neck pain but not neck tenderness, and three