Child cervical spine x ray4/8/2024 J Neurosurg 91:54–59ĭavis JW, Kaups KL, Cunningham MA, Parks SN, Nowak TP, Bilello JF, Williams JL (2001) Routine evaluation of the cervical spine in head-injured patients with dynamic fluoroscopy: a reappraisal. J Trauma 67:651–659ĭ'Alise MD, Benzel EC, Hart BL (1999) Magnetic resonance imaging evaluation of the cervical spine in the comatose or obtunded trauma patient. American College of Surgeons, ChicagoĬomo JJ, Thompson MA, Anderson JS, Shah RR, Claridge JA, Yowler CJ, Malangoni MA (2007) Is magnetic resonance imaging essential in clearing the cervical spine in obtunded patients with blunt trauma? J Trauma 63:544–549Ĭomo JJ, Diaz JJ, Dunham CM, Chiu WC, Duane TM, Capella JM, Holevar MR, Khwaja KA, Mayglothling JA, Shapiro MB, Winston ES (2009) Practice management guidelines for identification of cervical spine injuries following trauma: update from the eastern association for the surgery of trauma practice management guidelines committee. J Trauma 70(2):E24–E28Ĭommittee on Trauma-American College of Surgeons (2008) ATLS Advanced Trauma Life Support Program for Doctors. J Neurosurg Pediatr 5:292–296īrunetti MA, Mahesh M, Nabaweesi R, Locke P, Ziegfeld S, Brown R (2011) Diagnostic radiation exposure in pediatric trauma patients. Neurosurgery 50: S85–S99Īnderson RC, Kan P, Vanaman M, Rubsam J, Hansen KW, Scaife ER, Brockmeyer DL (2010) Utility of a cervical spine clearance protocol after trauma in children between 0 and 3 years of age. Grabb PA (2002) Management of pediatric cervical spine and spinal cord injuries. To definitively rule out ligamentous instability after a negative screening CT scan or cervical spine X-ray, these data support using flexion–extension X-rays with fluoroscopy and not MR imaging. The data support using either CT or plain radiographs as the initial cervical spine screening study, but CT is recommended because of its superior ability to detect critical injuries. MR imaging had a high false-positive rate, making it sensitive but not specific. Plain radiographs, flexion–extension radiographs, and CT all had high sensitivities and specificities. There was a low prevalence of cervical instability in this high-risk group. For CT, sensitivity was 100% and specificity was 95%, and for MR imaging, sensitivity was 100% and specificity was 74%. Plain cervical spine radiographs demonstrated sensitivity of 100% and specificity of 95% flexion–extension radiographs had “indeterminate” sensitivity and specificity of 100%. Sensitivity and specificity for each radiographic modality was determined. Patients underwent cervical spine flexion–extension radiographs 2–3 months after trauma to detect late instability. Each patient had plain radiographs, flexion–extension radiographs under fluoroscopy, computed tomography (CT), and magnetic resonance (MR) imaging within 10 days of admission. Twenty-four comatose, intubated children with severe traumatic injuries underwent radiographic evaluation to clear the cervical spine. We prospectively assessed the utility of four radiographic modalities to clear the cervical spine in children after severe trauma. Cervical spine clearance in severely injured children after trauma is often difficult because of unique injury patterns, concerns about radiation exposure to growing tissue, and unfamiliarity with unstable cervical injuries.
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