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A Novel Vertebral Stabilization Method for Producing Contusive Spinal Cord Injury
Published on: January 5, 2015
Cervical spine MRI in abused infants
K W Feldman1, E Weinberger, J M Milstein
1Department of Pediatrics, University of Washington, School of Medicine, Seattle, USA.
Insights
Cervical spine MRI is not recommended for children with head injuries from abuse unless they show clinical signs of cord injury. This screening method did not detect injuries in a study of abused children.
Area of Science:
- Pediatric Radiology
- Child Abuse Forensics
- Neurology
Background:
- Child abuse frequently involves head trauma.
- Cervical cord injury can occur in abusive head trauma but may be occult.
- Clinical suspicion for cervical cord injury is often absent in these cases.
Purpose of the Study:
- To evaluate the clinical utility of routine cervical spine MRI screening.
- To detect unsuspected cervical cord injury in children with abusive head trauma.
Main Methods:
- A prospective case series of 12 children with intracranial injury from child abuse.
- Cervical spine MRI was performed >3 days post-presentation or postmortem.
- Clinical and imaging data were analyzed for evidence of cervical cord injury.
Main Results:
- MRI did not identify any cervical cord injuries in the studied children.
- Autopsy revealed cervical spine hemorrhages in 4/5 children, which MRI failed to detect.
- No unsuspected cord injuries were identified via MRI screening.
Conclusions:
- Routine cervical spine MRI screening is not clinically useful for detecting unsuspected cord injuries in children with abusive head trauma.
- Current MRI protocols may not be sensitive enough to detect subtle cervical injuries in this population.
- Clinical assessment remains paramount in evaluating potential cervical spine trauma in abused children.
Objective:
To determine clinical utility of screening with cervical spine MRI to detect unsuspected cord injury in children with head injury from child abuse.
Design:
Prospectively collected case series. Setting-Tertiary care children's hospital and county medical examiner's office.
Patients:
Twelve children with intracranial injury secondary to child abuse. None was clinically suspected to have cord injury. Includes all eligible children whose attending felt: (a) needed follow-up cranial imaging: (b) could be safely imaged; and (c) whose caretakers consented between November, 1991 and September, 1994.
Interventions:
MRI scans of the cervical spine were obtained either more than 3 days after clinical presentation or postmortem.
Main Outcome Measures:
Clinical observations by neurologist, child protection team pediatrician and medicinal examiners by prospective protocol. MRI scans evaluated by prospective radiology protocol with emphasis on cervical cord injury.
Results:
Four of the five autopsied children had small subdural or subarachnoid hemorrhages at the level of the cervical spine; MRI scan did not identify them. MRI did not identify cord injury in any child studied.
Conclusion:
Routine cervical spine MRI scans are probably not warranted in children with head injury secondary to child abuse without clinical symptoms of cervical cord injury.
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