Journal article
Single-lateral cervical radiograph in pediatric trauma is equivalent to multiple views
The journal of trauma and acute care surgery, v 87(4), pp 813-817
01 Oct 2019
PMID: 31162331
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BACKGROUND: Cervical spine injuries (CSI) are rare within the pediatric population. Due to the significant consequences of missed CSI, children are often imaged excessively. In an attempt to decrease imaging of the cervical spine in children, we reviewed abnormal cervical radiographs (XR) to determine if the diagnosis of CSI could be made using a single-lateral cervical radiograph (LAT). Furthermore, we reviewed cervical computed tomography (CT) and magnetic resonance imaging (MRI) to ensure there were no missed CSI.
METHODS: Electronic medical records of trauma patients treated at a Level I Pediatric Trauma Center with abnormal XR findings followed by confirmatory CT or MRI between 2012 and 2017 were reviewed. All abnormal imaging on XR was compared with the LAT. In addition, all abnormal CTs and MRIs were reviewed to ensure there were no false negative XR.
RESULTS: A total of 3,735 XR were performed with 26 abnormal interpretations. All bony CSI were visualized on LAT. Confirmatory imaging found 13 (50%) were false positive and 13 (50%) were true positive. Secondary analysis of CT identified 12 injuries with prior XR; 8 of 12 LAT identifying the injury and 4 of 12 false positive on CT. Secondary analysis of MRI identified nine injuries with prior XR; 5 of 9 LAT identifying the injury. The four false-negative reads on MRI were ligamentous injuries.
CONCLUSION: Radiographs are commonly performed when evaluating CSI. In our population, initial assessment with a single LAT was equivalent to a multiple view XR. On secondary review, the only false-negative LAT reports were due to ligamentous injuries. This data suggests limiting exposure to LAT would accomplish the goal of reducing imaging without missing bony CSI and when ligamentous injury is suspected MRI should be the confirmatory study rather than CT. Copyright (C) 2019 Wolters Kluwer Health, Inc. All rights reserved.
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Details
- Title
- Single-lateral cervical radiograph in pediatric trauma is equivalent to multiple views
- Creators
- Erika B. Lindholm - Drexel UniversityArchana Malik - Drexel UniversityDarshan Parikh - St. Christopher's Hospital for ChildrenTara Mamdouhi - Drexel Univ, Coll Med, Philadelphia, PA 19104 USALauren Alper - Drexel Univ, Coll Med, Philadelphia, PA 19104 USAAutumn Nanassy - St Christophers Hosp Children, Div Pediat Gen Thorac & Minimally Invas Surg, Philadelphia, PA 19133 USASean Ciullo - St Christophers Hosp Children, Div Pediat Gen Thorac & Minimally Invas Surg, Philadelphia, PA 19133 USAL. Grier Arthur - St Christophers Hosp Children, Div Pediat Gen Thorac & Minimally Invas Surg, Philadelphia, PA 19133 USARajeev Prasad - St Christophers Hosp Children, Div Pediat Gen Thorac & Minimally Invas Surg, Philadelphia, PA 19133 USAMartin Herman - Drexel UniversityHarsh Grewal - St Christophers Hosp Children, Div Pediat Gen Thorac & Minimally Invas Surg, Philadelphia, PA 19133 USA
- Publication Details
- The journal of trauma and acute care surgery, v 87(4), pp 813-817
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 5
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pediatrics
- Web of Science ID
- WOS:000506812600010
- Scopus ID
- 2-s2.0-85072849317
- Other Identifier
- 991019168233204721
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Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Critical Care Medicine
- Surgery