Patterns in Follow-Up Imaging Usage for Pediatric Patients with Whiplash-Associated Disorder
Daryl P Fields1, Raj Swaroop Lavadi1, Joseph S Hudson1
1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Insights
Follow-up imaging for pediatric whiplash-associated disorder (WAD) did not reveal new structural injuries. This study suggests routine follow-up imaging may not be necessary for these patients.
Area of Science:
- Pediatric Traumatology
- Radiology
- Clinical Outcomes
Background:
- Clinical concern regarding missed or delayed structural injuries in pediatric whiplash-associated disorder (WAD).
- Initial imaging may be negative, raising questions about subsequent injury development.
Purpose of the Study:
- To assess the utilization of follow-up imaging in pediatric patients diagnosed with WAD.
- To determine if follow-up imaging reveals new structural injuries over time.
Main Methods:
- Retrospective review of 444 pediatric patients with WAD at a level 1 pediatric trauma center (2010-2019).
- Analysis of imaging at initial encounter and 3- and 6-month follow-ups.
- Correlation of imaging findings with persistent neck pain.
Main Results:
- Younger children (<6 years) were more likely to receive initial radiographs and MRI.
- Persistent neck pain was infrequent (<15%) at follow-up.
- Despite this, 80.2% at 3 months and 100% at 6 months had additional imaging, which did not reveal new structural injuries.
Conclusions:
- Follow-up imaging in pediatric WAD patients, with or without persistent pain, did not identify new structural pathology.
- Routine follow-up imaging may not be indicated for low-grade pediatric WAD.
Background:
A clinical concern exists that pediatric patients with whiplash-associated disorder (WAD) might have missed structural injuries or, alternatively, subsequently develop structural injuries over time, despite initially negative imaging findings. The primary objective of this study is to assess follow-up imaging usage for pediatric patients presenting with WAD.
Methods:
A retrospective review of 444 pediatric patients presenting to a level 1 pediatric trauma hospital from January 1, 2010 to December 31, 2019 was performed. Imaging was reviewed at the initial encounter and the 3- and 6-month follow-up appointments.
Results:
At the initial evaluation, children aged <6 years were more likely to receive radiographs (P = 0.007) and magnetic resonance imaging (P = 0.048) than were children aged 6-11 and 12-18 years. At the 3- and 6-month follow-up appointments, persistent neck pain was rare, representing <15% of patients at either time. Regardless of pain persistence, 80.2% of patients seen at the 3-month follow-up and 100% of patients at the 6-month follow-up underwent additional imaging studies. At the 3-month follow-up, children with persistent neck pain were more likely to undergo magnetic resonance imaging than were patients without persistent pain (P < 0.001). Also, patients with persistent neck pain were also more likely to not undergo any imaging evaluation (P = 0.002). Follow-up imaging studies did not reveal new structural injuries at either time point.
Conclusions:
Follow-up imaging for pediatric patients with low-grade WAD did not identify new structural pathology-in patients with or without persistent neck pain.
