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Can you see with CT? Is cervical spine computed tomographic imaging sufficient in pediatric trauma?

Krista J Stephenson1, Kori L Bullard2, Deidre L Wyrick1

  • 1Department of Pediatric Surgery, Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR, 72202, United States.

American Journal of Surgery
|March 15, 2023
PubMed

Insights

Cervical spine CT scans can miss injuries in children. A retroclival hematoma on CT requires careful evaluation, as it may indicate clinically significant cervical spine injury (CSI) missed by initial imaging.

Area of Science:

  • Pediatric Traumatology
  • Radiology
  • Emergency Medicine

Background:

  • Traumatic cervical spine injury (CSI) in children presents unique challenges compared to adults.
  • Current imaging recommendations for pediatric CSI are variable, highlighting the need for accurate diagnostic approaches.

Purpose of the Study:

  • To evaluate the incidence and clinical significance of CSI missed by initial cervical spine CT in pediatric patients.
  • To identify imaging findings that may indicate CSI overlooked on CT but detectable on MRI.

Main Methods:

  • Retrospective cohort study of children undergoing cervical spine CT after traumatic injury (7/1/2012 to 12/31/2019).
  • Analysis of CSI incidence on CT and subsequent MRI findings.
  • Review of CT images for potentially overlooked pathology in CSI cases.

Main Results:

  • Out of 1487 children with cervical spine CT, 52 had confirmed CSI.
  • Three cases of clinically significant CSI were initially missed by CT and later diagnosed by MRI.
  • Retrospective review identified retroclival hematomas on CT in these missed cases when using specific soft tissue window settings.

Conclusions:

  • A normal cervical spine CT may suffice to rule out clinically significant CSI in children.
  • The presence of a retroclival hematoma on CT necessitates thorough evaluation for potential CSI.
Abstract

Keywords:
Cervical spine imagingCervical spine injuryComputed tomographyMagnetic resonance imagingPediatric traumaRetroclival hematoma

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