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Isolated head injuries versus multiple trauma in pediatric patients: do the same indications for cervical spine
J L Laham1, D H Cotcamp, P A Gibbons
1Department of Critical Care, Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Pediatric patients with isolated head injuries need cervical spine imaging only if they are high-risk. High-risk children, including those unable to communicate or reporting neck pain, have a significantly higher chance of cervical spine injury.
Area of Science:
- Pediatric Traumatology
- Emergency Medicine
- Radiology
Background:
- Cervical spine injury evaluation guidelines are similar for isolated head injuries and multiple trauma.
- Risk factors for cervical spine injury in pediatric patients with isolated head trauma are not well-established.
Purpose of the Study:
- To identify risk factors for cervical spine injury in pediatric patients with isolated head injuries.
- To determine the necessity of cervical spine imaging in this patient population.
Main Methods:
- Retrospective chart review of 268 pediatric patients with isolated head injuries.
- Patients categorized into low-risk (verbal, no neck pain) and high-risk (non-verbal or neck pain) groups.
- Analysis of cervical spine injury incidence and associated risk factors.
Main Results:
- No cervical spine injuries were found in the low-risk group (n=135).
- Cervical spine trauma was present in 7.5% of high-risk patients (n=133).
- High-risk patients had a 23-fold increased likelihood of neck injury compared to low-risk patients.
Conclusions:
- Cervical spine X-rays are indicated only for high-risk pediatric patients with isolated head injuries.
- High-risk criteria include neck pain or inability to communicate symptoms due to age or injury severity.
- This approach can optimize imaging resource utilization in pediatric head trauma.
Abstract:
Although the recommendations to evaluate possible cervical spine injuries in patients with isolated head injuries are identical to those with multiple trauma, to date, no such study has confirmed that risk factors are the same for both injuries. We reviewed the charts of 268 pediatric patients with isolated head injuries admitted to the Intensive Care Unit at Children's Hospital Medical Center (1985-1990) to determine which risk factors were present. In this retrospective study, we divided the patients into two groups: low risk and high risk. The low-risk patients (n = 135) were those capable of verbal communication who did not report cervical discomfort. The high-risk patients (n = 133) either were incapable of verbal communication (preverbal or physically unable due to head injury) or reported neck pain. All patients under 2 years of age were considered preverbal and at high risk. The patients in both groups were indistinguishable by age, sex, mechanism of injury, and type of injury sustained. No patient in the low-risk group suffered cervical spine injury. Cervical spine trauma was present in 10 (7.5%) high-risk patients. Using the method of adjusted odds ratio, we found that high-risk patients had 23 times the likelihood of neck injury when compared with low-risk patients (p = 0.003, 95% confidence limit). Our results indicate that cervical spine X-rays (i.e., anteroposterior, odontoid, lateral views) are indicated only in high-risk pediatric patients with head injuries who either complain of neck pain or cannot voice such complaints because of significant head injury or preverbal age.(ABSTRACT TRUNCATED AT 250 WORDS)