Using CT of the cervical spine for early evaluation of pediatric patients with head trauma
H T Keenan1, M C Hollingshead, C J Chung
1Department of Pediatrics, CB 7220, 7701A 7th Floor, UNC Children's Hospital, University of North Carolina, 101 Manning Dr, Chapel Hill, NC 27599-7200, USA.
Insights
Performing early computed tomography (CT) of the cervical spine alongside head CT in pediatric patients with head trauma significantly reduces the need for repeat radiography. This approach enhances the efficiency of diagnosing pediatric cervical spine injuries.
Area of Science:
- Pediatric radiology
- Emergency medicine
- Trauma imaging
Background:
- Pediatric patients with head trauma often require imaging to rule out associated cervical spine injuries.
- Conventional radiography may lead to repeat imaging due to limitations in visualizing the pediatric cervical spine.
- Computed tomography (CT) is a valuable tool for evaluating complex injuries.
Purpose of the Study:
- To evaluate the effectiveness of adding cervical spine CT to head CT in pediatric patients with suspected head trauma.
- To determine if early cervical spine CT reduces the number of additional radiographs needed for clearance.
Main Methods:
- A retrospective review of 63 pediatric patients with head trauma who underwent both head CT and neck radiography.
- Comparison of demographics, clinical status, injury mechanism, and excess radiographs between patients who received early cervical spine CT and those who did not.
- Analysis of factors associated with the need for excess radiographs in the group not receiving early cervical spine CT.
Main Results:
- Twenty-one percent of patients underwent cervical spine CT at the time of head CT.
- Patients who received early cervical spine CT required significantly fewer excess radiographs (2.1 vs 3.6, p=0.04).
- Factors associated with excess radiographs included age over 8, unrestrained motor vehicle crash, Glasgow Coma Scale 13-15, and intubation.
Conclusions:
- Initial cervical spine CT at the time of head CT significantly decreases the number of repeated radiographs needed for injury assessment.
- Integrating cervical spine CT into trauma protocols for specific pediatric subgroups can improve the efficiency of cervical spine clearance.
- This strategy may lead to more effective and timely diagnosis of pediatric cervical spine injuries.
Objective:
The purpose of this study was to assess the effectiveness of CT of the cervical spine in addition to radiography in pediatric patients with suspected head trauma at the time of the CT head examination.
Materials And Methods:
We identified 63 pediatric patients admitted to the emergency department who had head trauma and who underwent both head CT and neck radiography. Those who underwent CT of the cervical spine at the time of the head CT examination during their initial evaluation were compared for demographics, clinical status, mechanism of injury, and number of excess radiographs (number required by protocol minus number of films obtained) required to evaluate the cervical spine with those patients who did not undergo early CT of the cervical spine.
Results:
Twenty-one patients (33%) underwent cervical spine CT at the time of the head CT examination. The number of excess radiographs differed significantly between these patients (2.1 +/- 2.6 vs 3.6 +/- 2.7, p = 0.04) and the comparison group. Patients who did not undergo early CT for whom excess radiographs were obtained had the following characteristics: they were older than 8 years (p = 0.03), were unrestrained in a motor vehicle crash (p = 0.04), had a Glasgow coma score of 13-15 (p = 0.01), and were intubated (p = 0.02).
Conclusion:
The number of repeated radiographs required to ascertain that the cervical spine is free of injury after suspected head trauma is significantly fewer when initial CT of the neck is performed at the time of head CT examination. Including cervical spine CT in trauma protocols for subgroups of children with head injuries may lead to more effective clearance of the pediatric cervical spine.
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