![]() ![]() Report details related to each patient were recorded for imaging modality, time and date of examination, indication for imaging, and injury type detected (if any) on imaging. Radiology reports were identified for each patient for trauma-related imaging, including plain film radiography, flexion-extension radiography, CT, and MRI. Both total ISS score and Head ISS scores were collected for each patient for whom scores were available. ISS is a widely used scoring system created by the Association for the Advancement of Automotive Medicine which assigns points based on injury severity and the body part affected. Information related to patient demographics (age, weight, height, insurance coverage), characteristics on presentation (Glasgow Coma Score (GCS), Injury Severity Score (ISS), emergency department (ED) symptoms), operative management (if any), and discharge disposition was collected. Trauma data were provided by our institution’s Trauma Report Database, which is affiliated with our Level 1 American College of Surgeons accredited trauma program. Only pediatric patients for whom a cervical collar was placed on or prior to admission for suspected cervical spine injury were included in this study. Our hypothesis is that FE radiography does not contribute significant diagnostic information following initial MRI or reduce time to cervical collar removal or discharge and thus can be removed from institutional protocols in order to avoid unnecessary testing and reduce pediatric radiation exposure.įollowing Institutional Review Board approval, we conducted a retrospective chart review of patients aged 18 years or younger who had been admitted to the pediatric intensive care unit (PICU) or pediatric medical floor for Level 1 or Level 2 acute trauma between Januand December 31, 2021. We also determined the subsequent impact of imaging findings on time to patient cervical collar clearance and time to hospital discharge. In this study, we assessed detection rates of bony and ligamentous injuries in both initial MRI evaluation and subsequent FE radiography in pediatric patients presenting with risk factors for cervical spinal cord injury in the setting of acute trauma. 3 Although initial MRI cervical spine evaluation in adult patients has been associated with a false-positive rate of between 25% and 40%, 4 the effectiveness of MRI as an initial imaging modality for acute trauma followed by FE radiography has not been evaluated in the pediatric population. However, MRI has demonstrated high sensitivity for both osseous and ligamentous injuries while also avoiding unnecessary radiation exposure in the pediatric patient population. ![]() Prior studies provided mixed evidence to support the use of either MRI or CT in the setting of acute pediatric trauma. While the American College of Radiology (ACR) Appropriateness Criteria for Suspected Spine Trauma in pediatric patients offer guidelines for best imaging practices in the setting of acute trauma, 2 there is a lack of uniformity in imaging-decision protocols across institutions, resulting in variable use of CT, MRI, plain radiographs (PFs), and flexion-extension (FE) radiographs as initial and secondary imaging modalities. 1 Thus, prompt and accurate diagnostic imaging is crucial for reducing patient morbidity and mortality in cases in which cervical spinal cord injury (SCI) is suspected. In pediatric blunt trauma patients, spinal cord injury without radiographic abnormality (SCIWORA) more commonly occurs in the cervical spine compared with the thoracic and lumbar regions. ![]()
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