Cervical spine clearance in unconscious pediatric trauma patients: a level l trauma center experience

Al-Sarheed, Saud; Alwatban, Jawaher J.; Alkhaibary, Ali; Babgi, Yaser; Al-Mohamadi, Waleed; Masuadi, Emad; Babtain, Ibrahim Al; Azzubi, Moutasem

doi:10.1007/s00381-019-04440-5

Cited by 11 publications

(12 citation statements)

References 12 publications

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“…Eleven thousand six hundred seventy-five participants were included in the overall injuries’ category (Table 1 ) [ 17 – 27 ]. Most injured children were males (74.6%).…”

Section: Resultsmentioning

confidence: 99%

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Epidemiology of childhood injuries in Saudi Arabia: a scoping review

Albedewi

Al-Saud

Kashkary³

et al. 2021

BMC Pediatr

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Background Injury is the leading cause of death among Saudi children. Despite that, much remains unknown on the epidemiology and the extent of burden. This scoping review aims to describe previous literature on injury burden, including types, causes, and outcomes. Methods We conducted a scoping literature search of English published articles on injuries among Saudi children between 0 to 18 years old using Scopus, MEDLINE, and Web of Science between January 2000 and December 2020. The primary outcome was the type and the cause of childhood injuries. Data extraction was based on specified data elements that included study characteristics and epidemiological parameters. The STROBE checklist was used to assess the quality of publications. Results The initial review identified 3,384 studies. Of which, 36 studies met the inclusion criteria. A total of 20,136 children were included; of them, 69% were males. Among studies that examined overall injuries, falls represented 31.9%, while 25.1% were due to Motor Vehicle Collision (MVC). The leading cause of fractures was falls (37.9%), followed by MVC (21.5%). The leading cause was flames (52.1%) followed by scald (36.4%) for burns. While for poisoning, medications were the leading cause of (39.9%), followed by toxic household products (25.7%). Weighted mortality rates were 5.2% for overall injuries, 8.3% for fractures of the skull and spine, and 17.4% for burns. Conclusions MVC and falls are associated with the highest share of injuries in the kingdom. These findings can guide prevention efforts to reduce injury burden and improve population health. Further population-based research is warranted to explore the determinants of childhood injuries across all regions of Saudi Arabia.

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“…Eleven thousand six hundred seventy-five participants were included in the overall injuries’ category (Table 1 ) [ 17 – 27 ]. Most injured children were males (74.6%).…”

Section: Resultsmentioning

confidence: 99%

“…The most common cause of injurie was falls (62.9%) followed by burns (22.9%). Riyadh 18 (Al-Sarheed et al, 2020) [ 27 ] 2005 - 2018 Retrospective N=62 Most trauma injuries occurred in males (77.4%). The most common cause of injury was MVC (59.7%), followed by pedestrian accidents (21%) and falls (14.5%).…”

Section: Resultsmentioning

confidence: 99%

Epidemiology of childhood injuries in Saudi Arabia: a scoping review

Albedewi

Al-Saud

Kashkary³

et al. 2021

BMC Pediatr

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“… 2 However, it has been suggested that in patients under the age of 5, the majority of cervical spine injuries occur in the upper cervical spine, where radiographs are prone to misdiagnosing C2/3 pseudo-subluxations, variability in epiphyseal growth centers, and unfused synchondroses as acute trauma-related injuries. 16 Although these guidelines acknowledge the limitations of radiography for visualization of soft-tissue injuries, the use of CT without contrast and MRI without contrast in the pediatric population are both currently placed at a lower level of recommendation (“May be Appropriate”) in cases of ambiguous radiographic findings due to insufficient evidence for which imaging technique may be superior.…”

Section: Discussionmentioning

confidence: 99%

Cervical spine flexion-extension radiography versus magnetic resonance imaging in pediatric patients following blunt traumatic injury

Zhang

Umenta

Ali

et al. 2023

Trauma Surg Acute Care Open

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BackgroundIn pediatric trauma patients, 60–80% of spinal cord injuries involve the cervical vertebrae. While the American College of Radiology offers guidelines for best imaging practices in the setting of acute pediatric trauma, there is a lack of uniformity in imaging-decision protocols across institutions. MRI has been shown to demonstrate high sensitivity for both bony and ligamentous injuries while also avoiding unnecessary radiation exposure in the pediatric patient population. However, the efficacy of flexion-extension (FE) radiography following initial MRI has not been evaluated in children. Our hypothesis is that FE radiography conducted following an initial MRI does not contribute significant diagnostic information or reduce time to cervical collar removal and thus can be removed from institutional protocols in order to avoid unnecessary testing and reduce pediatric radiation exposure.MethodsTrauma data were collected for pediatric patients presenting with suspected acute cervical spine injury from 2014 to 2021. A total of 108 patients were subdivided into 41 patients who received “MRI Only” and 67 patients who received both “MRI and FE” diagnostic cervical spine imaging. Chi-square testing and t-tests were performed to determine differences between MRI and FE radiographic detection rates of bony and ligamentous injuries in the subgroups.ResultsIn patients for whom FE did not find any injury, MRI detected bony and ligamentous injuries in 9/63 and 12/65 cases, respectively. In 3/21 (14.3%) cases in which MRI detected a bony and/or ligamentous injury and FE did not, patients eventually required surgical intervention for c-spine stabilization. No patients required surgical fixation when FE radiography showed an abnormality and MRI was normal. Addition of follow-up FE radiography after initial MRI did not have a significant effect on overall hospital length of stay (MRI Only vs MRI+FE: 9.2±12.0 days vs 8.6±13.5 days, p=0.816) or on rates of collar removal at discharge or greater than 48 hours after imaging (MRI Only vs MRI+FE: 41.5% vs 56.7%, p=0.124).ConclusionsFE radiography following initial MRI did not have a significant effect on reducing time to cervical collar removal or overall hospital length of stay. In addition, in 3 of 6 cases (50.0%) in which surgical fixation was required, MRI detected ligamentous and/or bony injury while FE radiography was normal.Level of EvidenceThis study contributes Level 2b scientific evidence consistent with a well-designed cohort or case-control analytic study.

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“…Both CT and MRI were 100% specific for clinically unstable injuries. However, Al-Sarheed et al [8] reported a 62-patient series wherein 5 children had an abnormal MRI after normal CT: one who underwent occipitocervical instrumented fusion and the rest managed by external orthosis. This raises the question of whether MRI might be preferred when pediatric radiologists are not available and if CT should only replace MRI in certain centers.…”

Section: Comparison Of Ct and Mrimentioning

confidence: 99%

“…Such a practice is enticing because MRI is more expensive, has a longer acquisition time, often requires anesthesia and airway, and is thought to be riskier and have a higher false-positive rate in the pediatric patient population. However, the literature is mixed [8]. MRI has traditionally been considered the most sensitive radiographic screen for CSI and, if done instead of CT, spares a vulnerable population from radiation exposure.…”

Section: Introductionmentioning

confidence: 99%

Weighing the Risk Profile of Cervical Spine MRI in Evaluating Pediatric Cervical Spine Injuries

et al. 2022

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Objective: Screening for cervical spine injury (CSI) after blunt trauma is common, but there remains varied practice patterns and clinical uncertainty regarding adequate radiographic evaluation. An oft-cited downside of MRI is the added risk compared to CT in the pediatric population; however, these specific risks have not yet been reported. This study examines the risks of cervical spine MRI in pediatric trauma patients in the context of what value MRI adds. Methods: Retrospective observational study of all pediatric blunt trauma patients who were evaluated with a cervical spine MRI over a four-year period at a level 1 pediatric trauma center. Clinical and radiographic data were abstracted, as well as anesthesia requirements and MRI-related major adverse events. CT and MRI results were compared for their ability to detect clinically unstable injuries—those requiring halo or surgery. Results: There was one major adverse event related to MRI among the 269 patients who underwent cervical spine MRI—a rate of 0.37%. While 55% of children had an airway and anesthesia for MRI, only 57% of these airways were newly placed for the MRI. None of the 85 patients newly intubated for MRI developed aspiration pneumonitis or ventilator-associated pneumonia, and no patients had a significant neurologic event while at MRI. Another area of the body was imaged concurrently with the cervical spine MRI in 64% of patients and 83% of MRIs were performed within 48 hours. CT and MRI were both 100% sensitive for injuries requiring halo or operative intervention. Eighty-three patients had an MRI performed after a negative CT, 11% (9/83) of these patients had a clinically stable injury detected on subsequent MRI, and none of these patients presented for delayed cervical spine complications. Conclusions: Overall, the safety profile of MRI in this setting is excellent and less than one-third of patients need new airway and anesthesia solely for MRI. In this clinical scenario, MRIs can happen relatively quickly and many patients require another body part to be imaged concurrently anyway. MRI and CT were both 100% sensitive for clinically unstable injuries. In the appropriate patients, MRI remains a safe and radiation-free alternative to CT.

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Cervical spine clearance in unconscious pediatric trauma patients: a level l trauma center experience

Cited by 11 publications

References 12 publications

Epidemiology of childhood injuries in Saudi Arabia: a scoping review

Epidemiology of childhood injuries in Saudi Arabia: a scoping review

Cervical spine flexion-extension radiography versus magnetic resonance imaging in pediatric patients following blunt traumatic injury

Weighing the Risk Profile of Cervical Spine MRI in Evaluating Pediatric Cervical Spine Injuries

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