- •Cervical spine CT is sufficient to detect clinically significant injury in children.
- •RetroClival hematoma is often overlooked and associated with ligamentous injury.
- •Protocols encompassing adequate view acquisition should be developed.
Traumatic cervical spine injury (CSI) is fundamentally different in children, and imaging recommendations vary; however, prompt diagnosis is necessary.
We conducted a retrospective cohort study, evaluating children who presented after traumatic injury from 7/1/2012 to 12/31/2019 receiving a cervical spine CT. Evaluation of the incidence and clinical significance of CSI undetected on CT subsequently diagnosed on MRI was conducted. Additionally, all with CSI underwent image review to evaluate for potential overlooked, but visible pathology.
1487 children underwent a cervical spine CT, revealing 52 with CSI. 237 underwent MRI due to an abnormal CT or continued clinical concern. Ultimately, three were discovered to have clinically significant CSI missed on CT. In all cases, retrospective review demonstrated a retroclival hematoma when soft tissue windows were formatted in sagittal and coronal views.
A normal CT may be sufficient to rule-out clinically significant CSI. However, the presence of a retroclival hematoma must be evaluated.
Abbreviations:CSI (cervical spine injury), CT (computed tomography), MRI (magnetic resonance imaging), CVJ (craniocervical junction), IQR (interquartile range), NPV (negative predictive value), PPV (positive predictive value), MVC (motor vehicle collision), PECARN (Pediatric Emergency Care Applied Research Network), NEXUS (National Emergency X-Radiology Utilization Study), CCR (Canadian C-spine Rule)
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Published online: March 02, 2023
Accepted: March 2, 2023
Received in revised form: February 28, 2023
Received: January 31, 2023
Publication stageIn Press Journal Pre-Proof
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