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.

BACKGROUND: A variety of radiologic screening protocols exist for evaluation of pediatric trauma patients with potential cervical spine (c-spine) injuries. The purpose of this study was to describe findings on c-spine magnetic resonance imaging (MRI) after previously normal c-spine computed tomographic (CT) scan findings at a Level 1 trauma center.

METHODS: A retrospective chart review of trauma patients evaluated at Rady Children's Hospital, San Diego, between January 2000 and February 2010 was conducted. Trauma patients who were younger than 18 years, placed in c-spine precautions, had a normal c-spine CT scan, who subsequently had a c-spine MRI were included. The sample was subdivided into patients who underwent CT scans between January 1, 2000 to July 31, 2005 (early group), and August 1, 2005 to February 28, 2010 (late group), to compare results between different CT scan resolutions.

RESULTS: A total of 173 patients met inclusion criteria. With 100% of patients demonstrating normal c-spine CT scan findings, 83% of c-spine MRI findings were also negative (p < 0.001). Thirty patients (17%) demonstrated significant abnormalities on MRI. Of the 30, 5 (2.9%) required operative c-spine stabilization. Eighty-five patients underwent CT scan in the early group, and 88 in the late group. All 5 patients with unstable injuries not discovered on CT scan were from the early group, compared with none in the late group (p = 0.027).

CONCLUSION: Our results suggest that high-resolution CT scan with sagittal and coronal reconstructions may be comparable with MRI for the detection of unstable c-spine injuries in pediatric trauma patients. Although minimizing CT scan radiation exposure remains essential, high-resolution c-spine CT scan may allow for earlier c-spine clearance with reduction of associated hard collar comorbidities in centers where MRI is not available or in situations where the patient's clinical stability precludes obtaining MRI.

LEVEL OF EVIDENCE: Diagnostic study, level III.