Abstract
Introduction: Significant cervical spine injuries in pediatric trauma patients are rare. The evaluation for cervical spine injuries is difficult in patients unable to participate in a physical exam and is complicated by behavior and cooperation in young children. The MRI scan is often used in patients unable to cooperate with the exam or with neck tenderness despite negative imaging. In order to determine the utility of this costly approach, we reviewed our experience using MRI scans for evaluation of cervical spine injuries in pediatric trauma patients. Methods: A retrospective analysis of our most recent 5-year experience with cervical spine evaluation in trauma patients was performed. Mechanism of injury, results of diagnostic tests, and management of identified injuries were recorded. Results: From January 2003 through December 2008, 198 patients underwent cervical spine MRI as part of the evaluation for possible trauma-related injury. No injury was identified in 128 patients. A possible injury was identified in 70 patients. Fifty-one of these patients had undergone the MRI for further evaluation of an injury identified on plain films or CT scan. Of the 19 patients with a new diagnosis found with MRI, 9 had a finding on physical exam (usually tenderness) that prompted the MRI. These were all stable with a collar used for comfort in 5 patients. The other 10 patients with potential injuries identified with MRI had no evidence of injury on initial films. The majority of these patients could not participate in physical exam due to neurologic impairment as the indication for MRI. The finding on MRI did not alter the management of any of these patients. Conclusions: The routine use of MRI for evaluation of cervical spine injuries does not significantly affect the management of pediatric trauma patients. These data suggest MRI is not a worthwhile technique for cervical spine clearance but might be best used for further evaluation of a documented injury.
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