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Majority of Paediatric Cervical Spine Injuries Are Detected by Radiography: Presented at AAP

By Crina Frincu-Mallos, PhD

WASHINGTON, DC -- October 21, 2009 -- Plain radiographs are reliable in detecting cervical spine injuries caused by blunt force trauma in more than 80% of children admitted at emergency departments, according to data reported here at the 2009 American Academy of Pediatrics (AAP) National Conference & Exhibition.

"The frequency of cervical spine injuries after blunt trauma in children is very low," according to first author Lise E. Nigrovic, MD, Children's Hospital and Harvard Medical School, Boston, Massachusetts. As a result, the usefulness of plain radiography to screen for cervical spine injury in children has not been elucidated, she added in a presentation given here October 16.

This retrospective analysis evaluated data from a cohort of more than 200 children with cervical spine injuries caused by blunt trauma. The investigators aimed to assess the use of plain radiographs in identifying bony or ligamentous cervical spine injuries in these children.

"Plain radiographs identified most of the cervical spine injuries in our cohort," said Dr. Nigrovic, adding that "among children with missed injuries, half had either altered mental status or focal neurological findings."

The children were admitted at 17 emergency departments participating in the Pediatric Emergency Care Applied Research Network (PECARN), Salt Lake, Utah, between 2000 and 2005.

This analysis included all children who had plain cervical spine radiographs for which there was a record at the study site. Four of the investigators assessed the injuries as "definite," "possible," or "negative" cervical spine injuries based on the radiology reports. The final attribution was made by a paediatric neurosurgeon who reviewed the case histories independently of the radiology reports, explained Dr. Nigrovic.

A total of 210 children (133 boys) met the inclusion criteria and their data was included in this retrospective analysis. The children had a median age of 12 years (interquartile range [IQR] 7-14 years).

Plain radiographs diagnosed definite or possible cervical spine injuries in 170 children (81%). More than half of the 40 remaining cases (n = 21) were considered to have poor quality radiographic films.

Of the 189 children with adequate cervical spine radiographs, 90% (n = 170) had definite or possible radiographic readings (95% confidence interval [CI] 86%-94%).

The radiographs did not identify the following cervical spine injuries: fracture only (n = 10), ligamentous injury alone (n = 4), and both fracture and ligamentous injury (n = 5). In addition, 10 of these children also presented with the following: endotracheal intubation (n = 4), altered mental status (n = 5), or focal neurological findings (n = 6).

"Further prospective studies are needed to determine which children at risk for cervical spine injuries will benefit from advanced imaging," concluded Dr. Nigrovic.

[Presentation Title: Utility of Plain Radiographs in Detecting Traumatic Injuries of the Cervical Spine in Children. Abstract 6832]

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