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Cervical spine trauma in children under 5 years: productivity of CT
J Alberto Hernandez1, Courtney Chupik, Leonard E Swischuk
1Department of Radiology, The University of Texas Medical Branch, Galveston, Texas, USA.
Insights
Computed tomography (CT) has limited value in diagnosing cervical spine trauma in children under 5. Most CT scans in this age group are negative for injury, with significant findings often visible on initial plain radiographs.
Area of Science:
- Pediatric Radiology
- Emergency Medicine
- Trauma Imaging
Background:
- Cervical spine trauma evaluation in young children presents diagnostic challenges.
- Plain radiography is often the initial imaging modality for suspected pediatric cervical spine injury.
Purpose of the Study:
- To assess the diagnostic utility of computed tomography (CT) for evaluating cervical spine trauma in children under 5 years old in the Emergency Department.
Main Methods:
- Retrospective review of 606 pediatric patients under 5 years undergoing cervical spine examination.
- Analysis of plain film and CT findings for fracture, dislocation, and instability.
- Documentation of patient age, sex, and imaging results.
Main Results:
- 75.7% of patients were cleared using clinical and plain film findings.
- CT was performed on 147 patients (24.3%) for further evaluation.
- Of those who underwent CT, 97.3% had negative findings for acute injury; only 2.7% showed positive findings, all visible on initial plain films.
Conclusions:
- The diagnostic yield of CT for clinically significant cervical spine injuries in children under 5 is low.
- CT provides minimal additional value when initial plain radiographs are negative or inconclusive for trauma.
- Routine CT imaging for cervical spine clearance in this pediatric population may not be cost-effective.
Abstract:
The aim of the study was to determine the value of CT in the evaluation of cervical spine trauma in children under 5 years in the Emergency Department. A retrospective review of 606 patients undergoing cervical spine examination in the emergency room was undertaken. The age and sex of the patients were documented, and in addition presence or absence of fracture-dislocation was noted on each of the plain film and CT studies. Of the 606 patients studied, 459 (75.7%) were cleared by a combination of clinical and plain film radiographic findings. The other 147 (24.3%) went on to CT imaging for clearing of the cervical spine. Of the 147 patients evaluated with CT, 143 (97.3%) had exams that were negative for fracture, dislocation, and instability. Only four (2.7%) demonstrated positive findings for fracture, dislocation, or instability. All of these patients had positive, diagnostic findings on initial plain film evaluation. Another five patients demonstrated new findings which were unrelated to trauma and of no clinical consequence. The yield of positive, clinically significant findings on CT of cervical spine injuries in children less than 5 years was low and showed significant findings only in patients where the same findings were seen on initial plain radiographs.
