Single-lateral cervical radiograph in pediatric trauma is equivalent to multiple views

Area of Science:

• Pediatric Traumatology
• Radiological Diagnostics
• Orthopedic Surgery

Background:

• Cervical spine injuries (CSI) are uncommon in children, but missed diagnoses have severe consequences.
• Excessive imaging of the pediatric cervical spine is prevalent due to concerns about missing CSI.
• This study aimed to reduce imaging burden by evaluating the diagnostic accuracy of a single lateral cervical radiograph (LAT).

Purpose of the Study:

• To determine if a single LAT can accurately diagnose CSI in pediatric trauma patients.
• To compare the diagnostic performance of LAT with multi-view radiography, CT, and MRI.
• To identify strategies for reducing unnecessary imaging while ensuring accurate CSI detection.

Main Methods:

• Retrospective review of electronic medical records from a Level I Pediatric Trauma Center (2012-2017).
• Analysis included trauma patients with abnormal cervical radiographs (XR) confirmed by CT or MRI.
• Comparison of findings from single LAT, multi-view XR, CT, and MRI for CSI detection.

Main Results:

• Of 3,735 XRs, 26 had abnormal interpretations; 13 were false positives, 13 true positives.
• All bony CSI were visualized on LAT.
• MRI identified four false-negative LAT reads, all representing ligamentous injuries.

Conclusions:

• A single LAT is a reliable screening tool for bony CSI in pediatric trauma.
• Limiting imaging to LAT can decrease radiation exposure without compromising the detection of bony injuries.
• MRI is the preferred confirmatory imaging modality for suspected ligamentous cervical spine injuries in children.