دورية أكاديمية
Pediatric cervical spine clearance: A 10-year evaluation of multidetector computed tomography at a level 1 pediatric trauma center.
العنوان: | Pediatric cervical spine clearance: A 10-year evaluation of multidetector computed tomography at a level 1 pediatric trauma center. |
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المؤلفون: | Russell KW; From the Division of Pediatric Surgery, Department of Surgery (K.W.R., S.E.I., K.M.S., N.E.P., K.E.L., T.M.B., S.J.F., R.A.S.) and Department of Neurosurgery (R.R.I., D.L.B.), University of Utah, Salt Lake City, Utah; Primary Children's Hospital, Salt Lake City, UT (K.L.B.); and Division of Trauma and Surgical Critical Care, Department of Surgery (K.I.), University of Southern California, Los Angles, CA., Iantorno SE, Iyer RR, Brockmeyer DL, Smith KM, Polukoff NE, Larsen KE, Barnes KL, Bell TM, Fenton SJ, Inaba K, Swendiman RA |
المصدر: | The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2023 Sep 01; Vol. 95 (3), pp. 354-360. Date of Electronic Publication: 2023 Apr 19. |
نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
اللغة: | English |
بيانات الدورية: | Publisher: Lippincott, Williams & Wilkins Country of Publication: United States NLM ID: 101570622 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2163-0763 (Electronic) Linking ISSN: 21630755 NLM ISO Abbreviation: J Trauma Acute Care Surg Subsets: MEDLINE |
أسماء مطبوعة: | Original Publication: Hagerstown, MD : Lippincott, Williams & Wilkins |
مواضيع طبية MeSH: | Wounds, Nonpenetrating*/diagnostic imaging , Spinal Injuries*/diagnostic imaging , Spinal Injuries*/surgery , Neck Injuries*, Humans ; Child ; Adolescent ; Multidetector Computed Tomography ; Prospective Studies ; Retrospective Studies ; Trauma Centers ; Cervical Vertebrae/diagnostic imaging ; Cervical Vertebrae/injuries ; Magnetic Resonance Imaging |
مستخلص: | Introduction: Efficient and accurate evaluation of the pediatric cervical spine (c-spine) for both injury identification and posttraumatic clearance remains a challenge. We aimed to determine the sensitivity of multidetector computed tomography (MDCT) for identification of cervical spine injuries (CSIs) in pediatric blunt trauma patients. Methods: A retrospective cohort study was conducted at a level 1 pediatric trauma center from 2012 to 2021. All pediatric trauma patients age younger than 18 years who underwent c-spine imaging (plain radiograph, MDCT, and/or magnetic resonance imaging [MRI]) were included. All patients with abnormal MRIs but normal MDCTs were reviewed by a pediatric spine surgeon to assess specific injury characteristics. Results: A total of 4,477 patients underwent c-spine imaging, and 60 (1.3%) were diagnosed with a clinically significant CSI that required surgery or a halo. These patients were older, more likely to be intubated, have a Glasgow Coma Scale score of <14, and more likely to be transferred in from a referring hospital. One patient with a fracture on radiography and neurologic symptoms got an MRI and no MDCT before operative repair. All other patients who underwent surgery including halo placement for a clinically significant CSI had their injury diagnosed by MDCT, representing a sensitivity of 100%. There were 17 patients with abnormal MRIs and normal MDCTs; none underwent surgery or halo placement. Imaging from these patients was reviewed by a pediatric spine surgeon, and no unstable injuries were identified. Conclusion: Multidetector computed tomography appears to have 100% sensitivity for detecting clinically significant CSIs in pediatric trauma patients, regardless of age or mental status. Forthcoming prospective data will be useful to confirm these results and inform recommendations for whether pediatric c-spine clearance can be safely performed based on the results of a normal MDCT alone. Level of Evidence: Diagnostic Tests or Criteria; Level IV. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.) |
References: | Viccellio P, Simon H, Pressman BD, Shah MN, Mower WR, Hoffman JR. A prospective multicenter study of cervical spine injury in children. Pediatrics . 2001;108(2):e20. Mohseni S, Talving P, Branco BC, Chan LS, Lustenberger T, Inaba K, et al. Effect of age on cervical spine injury in pediatric population: a National Trauma Data Bank review. J Pediatr Surg . 2011;46(9):1771–1776. Polk-Williams A, Carr BG, Blinman TA, Masiakos PT, Wiebe DJ, Nance ML. Cervical spine injury in young children: a National Trauma Data Bank review. J Pediatr Surg . 2008;43(9):1718–1721. Hauswald M, Ong G, Tandberg D, Omar Z. Out-of-hospital spinal immobilization: its effect on neurologic injury. Acad Emerg Med . 1998;5(3):214–219. Morris CGT, McCoy E. Cervical immobilisation collars in ICU: friend or foe? Anaesthesia . 2003;58(11):1051–1053. Hale DF, Fitzpatrick CM, Doski JJ, Stewart RM, Mueller DL. Absence of clinical findings reliably excludes unstable cervical spine injuries in children 5 years or younger. J Trauma Acute Care Surg . 2015;78(5):943–948. Nigrovic LE, Rogers AJ, Adelgais KM, Olsen CS, Leonard JR, Jaffe DM, et al. Utility of plain radiographs in detecting traumatic injuries of the cervical spine in children. Pediatr Emerg Care . 2012;28(5):426–432. Rice HE, Frush DP, Farmer D, Waldhausen JH; APSA Education Committee. Review of radiation risks from computed tomography: essentials for the pediatric surgeon. J Pediatr Surg . 2007;42(4):603–607. Herman MJ, Brown KO, Sponseller PD, Phillips JH, Petrucelli PM, Parikh DJ, et al. Pediatric cervical spine clearance: a consensus statement and algorithm from the pediatric cervical spine clearance working group. J Bone Joint Surg Am . 2019;101(1):e1. Frank JB, Lim CK, Flynn JM, Dormans JP. The efficacy of magnetic resonance imaging in pediatric cervical spine clearance. Spine . 2002;27(11):1176–1179. Flynn JM, Closkey RF, Mahboubi S, Dormans JP. Role of magnetic resonance imaging in the assessment of pediatric cervical spine injuries. J Pediatr Orthop . 2002;22(5):573–577. Gargas J, Yaszay B, Kruk P, Bastrom T, Shellington D, Khanna S. An analysis of cervical spine magnetic resonance imaging findings after normal computed tomographic imaging findings in pediatric trauma patients: ten-year experience of a level I pediatric trauma center. J Trauma Acute Care Surg . 2013;74(4):1102–1107. Patel MB, Humble SS, Cullinane DC, Day MA, Jawa RS, Devin CJ, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg . 2015;78(2):430–441. Leonard JR, Jaffe DM, Kuppermann N, Olsen CS, Leonard JC; Group PECARN (PECARN) CSS. Cervical spine injury patterns in children. Pediatrics . 2014;133(5):e1179–e1188. Leonard JC, Kuppermann N, Olsen C, Babcock-Cimpello L, Brown K, Mahajan P, et al. Factors associated with cervical spine injury in children after blunt trauma. Ann Emerg Med . 2011;58(2):145–155. Anderson RCE, Kan P, Vanaman M, Rubsam J, Hansen KW, Scaife ER, et al. Utility of a cervical spine clearance protocol after trauma in children between 0 and 3 years of age: clinical article. J Neurosurg Pediatr . 2010;5(3):292–296. Oh A, Sawvel M, Heaner D, Bhatia A, Reisner A, Tubbs RS, et al. Changes in use of cervical spine magnetic resonance imaging for pediatric patients with nonaccidental trauma. J Neurosurg Pediatr . 2017;20(3):271–277. Derderian SC, Greenan K, Mirsky DM, Stence NV, Graber S, Hankinson TC, et al. The utility of magnetic resonance imaging in pediatric trauma patients suspected of having cervical spine injuries. J Trauma Acute Care Surg . 2019;87(6):1328–1335. Qualls D, Leonard JR, Keller M, Pineda J, Leonard JC. Utility of magnetic resonance imaging in diagnosing cervical spine injury in children with severe traumatic brain injury. J Trauma Acute Care Surg . 2015;78(6):1122–1128. Brockmeyer DL, Ragel BT, Kestle JRW. The pediatric cervical spine instability study. Childs Nerv Syst . 2012;28(5):699–705. Inaba K, Byerly S, Bush LD, Martin MJ, Martin DT, Peck KA, et al. Cervical spinal clearance: a prospective western trauma association multi-institutional trial. J Trauma Acute Care Surg . 2016;81(6):1122–1130. Resnick S, Inaba K, Karamanos E, Pham M, Byerly S, Talving P, et al. Clinical relevance of magnetic resonance imaging in cervical spine clearance: a prospective study. JAMA Surg . 2014;149(9):934–939. Ham W, Schoonhoven L, Schuurmans MJ, Leenen LP. Pressure ulcers from spinal immobilization in trauma patients. J Trauma Acute Care Surg . 2014;76(4):1131–1141. Powers J, Daniels D, McGuire C, Hilbish C. The incidence of skin breakdown associated with use of cervical collars. J Trauma Nurs . 2006;13(4):198–200. Snyder EJ, Zhang W, Jasmin KC, Thankachan S, Donnelly LF. Gauging potential risk for patients in pediatric radiology by review of over 2,000 incident reports. Pediatr Radiol . 2018;48(13):1867–1874. Jaimes C, Murcia DJ, Miguel K, DeFuria C, Sagar P, Gee MS. Identification of quality improvement areas in pediatric MRI from analysis of patient safety reports. Pediatr Radiol . 2018;48(1):66–73. Hassan N, Butler C, DeCou J, Crumb T, Flohr S, Reischman D, et al. Pediatric cervical spine injuries on CT: difference in accuracy of interpretations by pediatric versus non-pediatric radiologists. Emerg Radiol . 2020;27(2):185–190. |
تواريخ الأحداث: | Date Created: 20230419 Date Completed: 20230824 Latest Revision: 20230828 |
رمز التحديث: | 20231215 |
DOI: | 10.1097/TA.0000000000003929 |
PMID: | 37072884 |
قاعدة البيانات: | MEDLINE |
تدمد: | 2163-0763 |
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DOI: | 10.1097/TA.0000000000003929 |