Clinical outcome following magnetic resonance imaging as first-line imaging in low-impact pediatric spine trauma: a single-center retrospective observational study

Sirén, Aapo; Nyman, Mikko; Syvänen, Johanna; Mattila, Kimmo; Hirvonen, Jussi

doi:10.1007/s00247-023-05721-7

Cited by 4 publications

(4 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, in our previous work, we found no missed injuries requiring surgical interventions after MRI as a first-line imaging in low-impact pediatric spinal trauma. 20 Therefore, we are confident that no patients with potentially unstable injuries would have left without adequate follow-up. Because of the excellent sensitivity of MRI, 7 the follow-up imaging may have been applied to patients whose injuries would not have been detected on CT or conventional radiographs and who would not have been followed up without an emergency MRI.…”

Section: Discussionmentioning

confidence: 93%

“…It has been shown that MRI can safely be used as a first-line imaging modality for low-impact pediatric spinal trauma. 20 The purpose of the current study was to examine the additional value of follow-up imaging after pediatric spinal trauma initially confirmed on MRI. Our hypothesis and practical rationale were that by leveraging the excellent accuracy of MRI in detecting and excluding spinal injuries, the amount of follow-up imaging of patients primarily scanned with emergency MRI could be reduced.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Outcomes of Follow-up Imaging After Pediatric Spinal Trauma Confirmed With Magnetic Resonance Imaging

Sirén,

Syvänen,

Nyman

et al. 2024

Journal of Pediatric Orthopaedics

Self Cite

View full text Add to dashboard Cite

Background: Imaging plays a crucial role in the diagnostic workup of pediatric spinal trauma. Computed tomography and conventional radiographs are widely used as the primary imaging methods. Magnetic resonance imaging (MRI) is a radiation-free alternative with high sensitivity for bony and soft tissue injuries. There is no consensus on the optimal use of follow-up imaging in pediatric spinal trauma without immediate surgical treatment, especially if the injury is primarily confirmed with MRI. This study aimed to assess the diagnostic value of follow-up imaging after MRI-confirmed spinal trauma in children. Methods: The medical records and the imaging data of children and adolescents with emergency spinal MRI and follow-up imaging over 8 years were retrospectively reviewed. The primary study outcome was the outcome of follow-up imaging and its effect on management. Results: The study population consisted of 127 patients. The follow-up imaging did not alter the management in any patient with presumably stable injury in emergency MRI. Short-term follow-up imaging showed no clinically significant progression in thoracolumbar compression fractures. Flexion-extension radiographs had no additional value in cases with stable cervical spinal injury on emergency MRI. Conclusions: The clinical utility of short-term follow-up imaging is low in children with stable spinal injury on emergency MRI. Level of evidence: Level III—retrospective observational study.

show abstract

Section: Discussionmentioning

confidence: 93%

mentioning

confidence: 99%

Outcomes of Follow-up Imaging After Pediatric Spinal Trauma Confirmed With Magnetic Resonance Imaging

Sirén,

Syvänen,

Nyman

et al. 2024

Journal of Pediatric Orthopaedics

Self Cite

View full text Add to dashboard Cite

show abstract

“…Young or distressed children might need anesthesia for an MRI, which may not be needed for CT scanning. Previous studies did not show negative affects concerning anesthesia for MRI in small numbers of pediatric trauma patients [12,14,15,20]. However, the APRICOT trial showed that, especially in children, there are risks concerning anesthesia [21].…”

Section: Discussionmentioning

confidence: 97%

“…Considering the increased risk of leukemia and brain cancer after ionizing radiation for CT scanning in early life, a possible the next step could be magnetic resonance imaging (MRI) after conventional X-ray to reduce the long-term risk of cancer and accurately diagnose or rule out spinal injuries [12][13][14]. Furthermore, MRI is able to visualize non-osseus tissues, contrary to CT scanning [15][16][17]. The new Dutch guidelines, implemented in 2022, incorporate these risks for the pediatric population and advise conventional X-ray as the first step, with dedicated MRI reserved for patients with neurological deficits [14].…”

Section: Introductionmentioning

confidence: 99%

Traumatic Spinal Injury in Children; Time to Revise Pre-Hospital and Diagnostic Protocols?

Oude Alink,

Stassen,

Spoor

et al. 2024

JCM

View full text Add to dashboard Cite

Background: Traumatic spinal injury in children is a rare but serious life event. Predicting pediatric patients at risk for spinal injury remains difficult. This study focuses on the cause of the injury and predictors to identify children at risk and appropriate diagnostic procedures. Methods: Retrospective chart review from the Landelijke Trauma Registratie of patients with spinal injury from 2010 to 2021 in a level 1 pediatric trauma center. Results: We included 114 children with spinal injury, 79.8% of whom were aged 12–17 years. In the overall trauma population, the incidence of spinal injury was 10% in children aged 12–17 years, 2.3% in children aged 6–11 years, and 0.4% in children 0–5 years of age. Neurological deficits were present in 27.2% of patients in the emergency department, with permanent deficits in 14.0%. Spinal fractures were present in 91.2% of 12–17-year-olds, 43.8% in 6–11-year-olds, and 71.4% in 0–5-year-olds. ISS was 23 (SD 14) in children with spinal injury compared to 8 (SD 9) for children without spinal injury. Conclusions: In children 0–11 years old, spinal injury is very rare compared to the overall trauma population, and there are more non-osseous injuries. Clinicians should consider MRI as the next step after conventional X-ray to diagnose or exclude spinal injuries in this group. In older children aged 12–17 years, the incidence of spinal injury is much higher, at 10%. Although ISS is higher in children with spinal injury, a low ISS does not exclude spinal injury. If one fracture is found, more fractures in other regions of the spine may be present.

show abstract

Utility of brain imaging in pediatric patients with a suspected accidental spinal injury but no brain injury-related symptoms

Sirén,

Nyman,

Syvänen

et al. 2024

Childs Nerv Syst

View full text Add to dashboard Cite

Purpose Imaging is the gold standard in diagnosing traumatic brain injury, but unnecessary scans should be avoided, especially in children and adolescents. Clinical decision-making rules often help to distinguish the patients who need imaging, but if spinal trauma is suspected, concomitant brain imaging is often conducted. Whether the co-occurrence of brain and spine injuries is high enough to justify head imaging in patients without symptoms suggesting brain injury is unknown. Objective This study aims to assess the diagnostic yield of brain MRI in pediatric patients with suspected or confirmed accidental spinal trauma but no potential brain injury symptoms. Methods We retrospectively reviewed the medical and imaging data of pediatric patients (under 18 years old) who have undergone concomitant MRI of the brain and spine because of acute spinal trauma in our emergency radiology department over a period of 8 years. We compared the brain MRI findings in patients with and without symptoms suggesting brain injury and contrasted spine and brain MRI findings. Results Of 179 patients (mean age 11.7 years, range 0–17), 137 had symptoms or clinical findings suggesting brain injury, and 42 did not. None of the patients without potential brain injury symptoms had traumatic findings in brain MRI. This finding also applied to patients with high-energy trauma (n = 47) and was unrelated to spinal MRI findings. Conclusion Pediatric accidental trauma patients with suspected or confirmed spine trauma but no symptoms or clinical findings suggesting brain injury seem not to benefit from brain imaging.

show abstract

Clinical outcome following magnetic resonance imaging as first-line imaging in low-impact pediatric spine trauma: a single-center retrospective observational study

Cited by 4 publications

References 25 publications

Outcomes of Follow-up Imaging After Pediatric Spinal Trauma Confirmed With Magnetic Resonance Imaging

Outcomes of Follow-up Imaging After Pediatric Spinal Trauma Confirmed With Magnetic Resonance Imaging

Traumatic Spinal Injury in Children; Time to Revise Pre-Hospital and Diagnostic Protocols?

Utility of brain imaging in pediatric patients with a suspected accidental spinal injury but no brain injury-related symptoms

Contact Info

Product

Resources

About