Sensitivity of plain radiography for pediatric cervical spine injury

Cui, Li W.; Probst, Marc A.; Hoffman, Jerome R.; Mower, William R.

doi:10.1007/s10140-016-1417-y

Cited by 13 publications

(7 citation statements)

References 22 publications

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“…Despite a movement toward CT as the initial screening tool, cervical spine X-ray followed by MRI remains a viable alternative to reduce radiation. Several recent reports have demonstrated excellent sensitivity of X-ray for CSI [20, 21]. Lindholm et al [22] showed that even a single lateral-view X-ray was equivalent to multiple views and had 100% sensitivity for bony injuries.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…If CSI is suspected, various international trauma guidelines recommend plain radiography of the C-spine as primary imaging in children [11,16]. Its sensitivity for detecting CSI is higher than 90% [9,11,[17][18][19]. A CT scan of the C-spine is only indicated in those patients for whom a fracture is seen on plain radiography or for whom there is clinical suspicion of CSI despite a negative result with plain radiography [20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre

Brinke

Slinger

Slaar³

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Cervical spine injury after blunt trauma in children is rare but can have severe consequences. Clear protocols for diagnostic workup are, therefore, needed, but currently not available. As a step in developing such a protocol, we determined the incidence of cervical spine injury and the degree of protocol adherence at our level 2 trauma centre. Methods We analysed data from all patients aged < 16 years suspected of cervical spine injury after blunt trauma who had presented to our hospital during two periods: January 2010 to June 2012, and January 2017 to June 2019. In the intervening period, the imaging protocol for diagnostic workup was updated. Outcomes were the incidence of cervical spine injury and protocol adherence in terms of the indication for imaging and the type of imaging. Results We included 170 children in the first study period and 83 in the second. One patient was diagnosed with cervical spine injury. Protocol adherence regarding the indication for imaging was > 80% in both periods. Adherence regarding the imaging type decreased over time, with 45.8% of the patients receiving a primary CT scan in the second study period versus 2.9% in the first. Conclusion Radiographic imaging is frequently performed when clearing the paediatric cervical spine, although cervical spine injury is rare. Particularly CT scan usage has wrongly been emerging over time. Stricter adherence to current protocols could limit overuse of radiographic imaging, but ultimately there is a need for an accurate rule predicting which children really are at risk of injury.

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“…Conventional film images are frequently the initial imaging modality of choice (14). Cervical spine radiographs have been shown to have high sensitivity, and cervical spine trauma algorithms with radiography used as the initial examination have demonstrated high sensitivity and specificity for cervical spine injuries (17,18). The recommended radiographic series for pediatric cervical spine trauma consists of frontal and lateral radiographs (14).…”

Section: Cervical Spine Radiographymentioning

confidence: 99%

Emergent Imaging of Pediatric Cervical Spine Trauma

2019

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Owing to physiologic and biomechanical differences, the incidence, patterns, distributions, and mechanisms of spinal injury in children differ from those in adults. Furthermore, evaluation of the spine can be complicated by synchondroses, developmental and/or anatomic variants, and interpretative pitfalls that are unique to the developing spine of a child. Although the incidence of spinal injury is lower in children, the sequelae are more severe, with higher morbidity and mortality. Mechanistic differences, notably nonaccidental trauma in infants and toddlers; physiologic differences, notably a disproportionately large head relative to body size and ligamentous and soft-tissue laxity; and the propensity of these injuries to occur at higher spinal levels (craniocervical junction to C3) are contributing factors. In addition, imaging recommendations for children are different. Assessment of spinal alignment and adjacent soft tissues, particularly at the craniocervical junction, with a low threshold for performing MRI, is key to diagnosing these serious injuries. The patterns of common pediatric cervical spine injuries, including craniocervical junction injury and spinal cord injury without a correlating radiographic abnormality, are reviewed. © RSNA, 2019 • radiographics.rsna.org

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Sensitivity of plain radiography for pediatric cervical spine injury

Cited by 13 publications

References 22 publications

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

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

Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre

Emergent Imaging of Pediatric Cervical Spine Trauma

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