Highlights
- •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.
Abstract
Background
Traumatic cervical spine injury (CSI) is fundamentally different in children, and
imaging recommendations vary; however, prompt diagnosis is necessary.
Methods
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.
Results
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.
Conclusions
A normal CT may be sufficient to rule-out clinically significant CSI. However, the
presence of a retroclival hematoma must be evaluated.
Keywords
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 02, 2023
Accepted:
March 2,
2023
Received in revised form:
February 28,
2023
Received:
January 31,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
