Faculty Collaboration Database

The sensitivity of limited-sequence magnetic resonance imaging in identifying pediatric cervical spine injury: A Western Pediatric Surgery Research Consortium multicenter retrospective cohort study. J Trauma Acute Care Surg 2024 Sep 01;97(3):407-413

Date

03/25/2024

Pubmed ID

38523120

DOI

10.1097/TA.0000000000004271

Scopus ID

2-s2.0-85201911563 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

INTRODUCTION: Clinical clearance of a child's cervical spine after trauma is often challenging because of impaired mental status or an unreliable neurologic examination. Magnetic resonance imaging (MRI) is the criterion standard for excluding ligamentous injury in children but is constrained by long image acquisition times and frequent need for anesthesia. Limited-sequence magnetic resonance imaging (LSMRI) is used in evaluating the evolution of traumatic brain injury and may also be useful for cervical spine clearance while potentially avoiding the need for anesthesia. The purpose of this study was to assess the sensitivity and negative predictive value of LSMRI as compared with criterion standard full-sequence MRI as a screening tool to rule out clinically significant ligamentous cervical spine injury.

METHODS: We conducted a 10-center, 5-year retrospective cohort study (2017-2021) of all children (0-18 years) with a cervical spine MRI after blunt trauma. Magnetic resonance imaging images were rereviewed by a study pediatric radiologist at each site to determine if the presence of an injury could be identified on limited sequences alone. Unstable cervical spine injury was determined by study neurosurgeon review at each site.

RESULTS: We identified 2,663 children younger than 18 years who underwent an MRI of the cervical spine with 1,008 injuries detected on full-sequence studies. The sensitivity and negative predictive value of LSMRI were both >99% for detecting any injury and 100% for detecting any unstable injury. Young children (younger than 5 years) were more likely to be electively intubated or sedated for cervical spine MRI.

CONCLUSION: Limited-sequence magnetic resonance imaging is reliably detects clinically significant ligamentous injury in children after blunt trauma. To decrease anesthesia use and minimize MRI time, trauma centers should develop LSMRI screening protocols for children without a reliable neurologic examination.

LEVEL OF EVIDENCE: Diagnostic Test/Criteria; Level III.

Author List

Melhado C, Durand R, Russell KW, Polukoff NE, Rampton J, Iyer RR, Acker SN, Koehler R, Prendergast C, Stence N, O'Neill B, Padilla BE, Jamshidi R, Vaughn JA, Ronecker JS, Selesner L, Lofberg K, Regner M, Thiessen J, Sayama C, Spurrier RG, Ross EE, Liu CJ, Chu J, McNevin K, Beni C, Robinson BRH, Linnau K, Buckley RT, Chao SD, Sabapaty A, Tong E, Prolo LM, Ignacio R, Sachs GF, Kruk P, Gonda D, Ryan M, Pandya S, Koral K, Braga BP, Auguste K, Jensen AR, Western Pediatric Surgery Research Consortium Cervical Spine Injury Study Group

Author

Michael Regner MD Associate Professor in the Radiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Cervical Vertebrae
Child
Child, Preschool
Female
Humans
Infant
Infant, Newborn
Magnetic Resonance Imaging
Male
Predictive Value of Tests
Retrospective Studies
Sensitivity and Specificity
Spinal Injuries
Wounds, Nonpenetrating