David Qualls1, Jeffrey R Leonard, Martin Keller, Jose Pineda, Julie C Leonard. 1. From the Washington University in St. Louis School of Medicine (D.Q., J.R.L., M.K., J.P., J.C.L.) St. Louis, Missouri; St. Louis Children's Hospital (M.K., J.P.), St. Louis, Missouri; Nationwide Children's Hospital and the Ohio State University College of Medicine (J.R.L., J.C.L.), Columbus, Ohio.
Abstract
BACKGROUND: Evaluation of children for cervical spine injuries (CSIs) after blunt trauma is complicated, particularly if the patient is unresponsive because of severe traumatic brain injury. Plain radiography and computed tomography (CT) are commonly used, but CT combined with magnetic resonance imaging (MRI) is still considered the gold standard in CSI detection. However, MRI is expensive and can delay cervical clearance. The purpose of this study is to determine the added benefit of MRI as an adjunct to CT in the clearance of children with severe head trauma. METHODS: We performed a retrospective chart review of pediatric head trauma patients admitted to the pediatric intensive care unit at St. Louis Children's Hospital from 2002 to 2012. Patients who received both cervical spine CT and MRI and presented with a Glasgow Coma Scale score of 8 or lower were included in the study. Imaging was analyzed by two pediatric trauma subspecialists and classified as demonstrating "no injury," "stable injury," or "unstable injury." Results were compared, and discrepancies between CT and MRI findings were noted. RESULTS: A total of 1,196 head-injured children were admitted to the pediatric intensive care unit between January 2002 and December 2012. Sixty-three children underwent CT and MRI and met Glasgow Coma Scale criteria. Seven children were identified with negative CT and positive MRI findings, but none of these injuries were considered unstable by our criteria. Five children were determined to have unstable injuries, and all were detected on CT. CONCLUSION: The results of this study suggest that MRI does not detect unstable CSIs in the setting of negative CT imaging. Given the limited patient population for this study, further and more extensive studies investigating the utility of MRI in the head-injured pediatric patient are warranted. LEVEL OF EVIDENCE: Diagnostic and care management study, level IV.
BACKGROUND: Evaluation of children for cervical spine injuries (CSIs) after blunt trauma is complicated, particularly if the patient is unresponsive because of severe traumatic brain injury. Plain radiography and computed tomography (CT) are commonly used, but CT combined with magnetic resonance imaging (MRI) is still considered the gold standard in CSI detection. However, MRI is expensive and can delay cervical clearance. The purpose of this study is to determine the added benefit of MRI as an adjunct to CT in the clearance of children with severe head trauma. METHODS: We performed a retrospective chart review of pediatric head traumapatients admitted to the pediatric intensive care unit at St. Louis Children's Hospital from 2002 to 2012. Patients who received both cervical spine CT and MRI and presented with a Glasgow Coma Scale score of 8 or lower were included in the study. Imaging was analyzed by two pediatric trauma subspecialists and classified as demonstrating "no injury," "stable injury," or "unstable injury." Results were compared, and discrepancies between CT and MRI findings were noted. RESULTS: A total of 1,196 head-injured children were admitted to the pediatric intensive care unit between January 2002 and December 2012. Sixty-three children underwent CT and MRI and met Glasgow Coma Scale criteria. Seven children were identified with negative CT and positive MRI findings, but none of these injuries were considered unstable by our criteria. Five children were determined to have unstable injuries, and all were detected on CT. CONCLUSION: The results of this study suggest that MRI does not detect unstable CSIs in the setting of negative CT imaging. Given the limited patient population for this study, further and more extensive studies investigating the utility of MRI in the head-injured pediatric patient are warranted. LEVEL OF EVIDENCE: Diagnostic and care management study, level IV.
Authors: Justin M Moore; Jonathan Hall; Michael Ditchfield; Christopher Xenos; Andrew Danks Journal: Childs Nerv Syst Date: 2016-12-06 Impact factor: 1.475
Authors: Saud Al-Sarheed; Jawaher Alwatban; Ali Alkhaibary; Yaser Babgi; Waleed Al-Mohamadi; Emad M Masuadi; Ibrahim Al Babtain; Moutasem Azzubi Journal: Childs Nerv Syst Date: 2019-12-09 Impact factor: 1.475