Wednesday, September 26, 2018 10:35 AM – 12:00 PM Cervical Spine Trauma: 25. CT imaging of the spine in pediatric trauma patients: prevalence of fractures and mechanisms of injury

Abstract

BACKGROUND CONTEXT Computed tomography (CT) scans have become ubiquitous in the assessment of the trauma patient because of its diagnostic acuity in assessing head and axial skeletal pathology. Consensus recommendations exist for limiting the ionizing radiation dose as it pertains to CT head imaging in the pediatric population. However, little published data exist assessing the diagnostic yield of current practices in the pediatric population. As pressure mounts to diagnose emergent pathologies in the emergency department, children are at risk for a relatively high cumulative burden as sequela of medical imaging such as an increased lifetime attributable risk of cancer. PURPOSE To evaluate the diagnostic yield of CT scans of the spine in pediatric trauma patients STUDY DESIGN/SETTING Retrospective, Level I trauma center. PATIENT SAMPLE Patients 18 and under, undergoing CT scans in the ER 1/2013-12/2015. OUTCOME MEASURES Presence of fracture. METHODS Medical records of pediatric trauma patients who arrived at the emergency department and underwent spinal CT were reviewed. We reviewed the CT scans as well as the radiology reports for fractures. Medical records were reviewed for mechanism of injury and management for these patients as well as demographics. Factors associated with pediatric patients with fractures were then compared to those without fractures. RESULTS A total of 831 patients underwent CT scans in to the ER. Average age was 13.86 years (0.24-18.99) with 43% (355) females and 57% (476) males. The racial demographics were as follows: 70% Caucasian, 20% African American, 1.4% Asian, with the remainder listed as other or not available. The most common mechanism of injury (MOI) was motor vehicle accident (MVA) (26%) followed by sports injury (18%), then fall from height (15%) bicycle/motor bike (14%). Other mechanisms of injury were pedestrian struck (9.5%), assault (5%), syncope (3%), direct head blow (3%), neck pain (2%), fall from standing (1%), seizure (1%), strangulation/hanging ( CONCLUSIONS It is important to consider the long-term implications when deciding to expose a pediatric patient to radiation. In this study we found the overall axial fracture rate to be low (6.1%). The fractures were distributed throughout the mobile spine and sacrum. Of the fractures that were detected 54% were transverse process and compression fractures. Pediatric trauma CT scanning best practices focusing on MOI most likely resulting in spine fractures (MVA, bike/motor bike, sport injuries) should be investigated. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.