Do additional views improve the diagnostic performance of cervical spine radiography in pediatric trauma?

The aims of this study were to measure the diagnostic performances of lateral views alone and multiple radiographic views of the cervical spine in comparison with MDCT scans in pediatric trauma and to determine whether evaluation of additional views, in relation to lateral views alone, improves the performance of radiography.

Retrospective analysis of cervical spine radiographs of 234 pediatric patients (age range, 3 months-17 years 11 months) who had been seen in our pediatric emergency department during the period of 2000-2005 for evaluation after acute trauma was performed. All patients underwent cervical spine MDCT examination at the same presentation. Radiographs were evaluated for the presence of fractures, subluxations, and dislocations. Radiographic abnormalities were correlated to findings on MDCT, which was used as the reference standard.

Twenty-two patients had positive findings on CT: Atlantooccipital subluxation/dislocation was seen in one patient; C1 ring fracture, in three patients; C1-C2 rotatory subluxation, in one; C1-C2 subluxation/dislocation, in one; odontoid fracture, in two; vertebral body wedge fracture, in six; posterior arch fracture dislocation, in 10; and spinous process fracture, in none. The lateral view radiograph alone had 73% sensitivity (95% CI, 50-89%) and 92% specificity (95% CI, 87-95%) for cervical spine abnormalities compared with MDCT. The addition of other views did not change the sensitivity of radiography but rather marginally decreased its specificity to 91% (95% CI, 86-94%).

Lateral view radiographs had a borderline acceptable sensitivity to cervical spine abnormalities in pediatric patients compared with MDCT. The addition of other radiographic views did not seem to improve the diagnostic performance of radiography.