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Pediatric cervical spine clearance: A 10-year evaluation of multidetector computed tomography at a level 1 pediatric
Katie W Russell1, Stephanie E Iantorno, Rajiv R Iyer
1From the Division of Pediatric Surgery, Department of Surgery (K.W.R., S.E.I., K.M.S., N.E.P., K.E.L., T.M.B., S.J.F., R.A.S.) and Department of Neurosurgery (R.R.I., D.L.B.), University of Utah, Salt Lake City, Utah; Primary Children's Hospital, Salt Lake City, UT (K.L.B.); and Division of Trauma and Surgical Critical Care, Department of Surgery (K.I.), University of Southern California, Los Angles, CA.
Insights
Multidetector computed tomography (MDCT) shows 100% sensitivity in identifying significant pediatric cervical spine injuries (CSIs). This imaging modality can potentially aid in safely clearing pediatric patients after blunt trauma.
Area of Science:
- Pediatric Traumatology
- Diagnostic Imaging
- Spine Surgery
Background:
- Evaluating pediatric cervical spine (c-spine) injuries and ensuring post-traumatic clearance is challenging.
- Multidetector computed tomography (MDCT) is increasingly used for imaging, but its diagnostic accuracy in pediatric blunt trauma requires further evaluation.
Purpose of the Study:
- To determine the sensitivity of MDCT for identifying cervical spine injuries (CSIs) in pediatric blunt trauma patients.
Main Methods:
- A retrospective cohort study included 4,477 pediatric patients (<18 years) who underwent c-spine imaging (radiography, MDCT, MRI) from 2012-2021.
- Patients with abnormal MRIs and normal MDCTs were reviewed by a pediatric spine surgeon.
Main Results:
- Of 4,477 patients, 60 (1.3%) had clinically significant CSIs. MDCT diagnosed all surgically treated or halo-requiring injuries, yielding 100% sensitivity.
- 17 patients with abnormal MRIs and normal MDCTs had no unstable injuries identified upon review.
Conclusions:
- MDCT demonstrates 100% sensitivity for detecting clinically significant CSIs in pediatric trauma patients.
- Further prospective studies are needed to confirm if MDCT alone can safely clear the pediatric c-spine.
Introduction:
Efficient and accurate evaluation of the pediatric cervical spine (c-spine) for both injury identification and posttraumatic clearance remains a challenge. We aimed to determine the sensitivity of multidetector computed tomography (MDCT) for identification of cervical spine injuries (CSIs) in pediatric blunt trauma patients.
Methods:
A retrospective cohort study was conducted at a level 1 pediatric trauma center from 2012 to 2021. All pediatric trauma patients age younger than 18 years who underwent c-spine imaging (plain radiograph, MDCT, and/or magnetic resonance imaging [MRI]) were included. All patients with abnormal MRIs but normal MDCTs were reviewed by a pediatric spine surgeon to assess specific injury characteristics.
Results:
A total of 4,477 patients underwent c-spine imaging, and 60 (1.3%) were diagnosed with a clinically significant CSI that required surgery or a halo. These patients were older, more likely to be intubated, have a Glasgow Coma Scale score of <14, and more likely to be transferred in from a referring hospital. One patient with a fracture on radiography and neurologic symptoms got an MRI and no MDCT before operative repair. All other patients who underwent surgery including halo placement for a clinically significant CSI had their injury diagnosed by MDCT, representing a sensitivity of 100%. There were 17 patients with abnormal MRIs and normal MDCTs; none underwent surgery or halo placement. Imaging from these patients was reviewed by a pediatric spine surgeon, and no unstable injuries were identified.
Conclusion:
Multidetector computed tomography appears to have 100% sensitivity for detecting clinically significant CSIs in pediatric trauma patients, regardless of age or mental status. Forthcoming prospective data will be useful to confirm these results and inform recommendations for whether pediatric c-spine clearance can be safely performed based on the results of a normal MDCT alone.
Level Of Evidence:
Diagnostic Tests or Criteria; Level IV.
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