Cervical Spine Imaging in Hospitalized Children With Traumatic Brain Injury

Bennett, Tellen D.; Bratton, Susan L.; Riva-Cambrin, Jay; Scaife, Eric R.; Nance, Michael L.; Prince, Jeffrey S.; Wilkes, Jacob; Keenan, Heather T.

doi:10.1097/pec.0000000000000395

Cited by 9 publications

(7 citation statements)

References 30 publications

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“…However, cervical CT use increased in children < 18 years with TBI between 2001 and 2011 at select children's hospitals, though the rate of rise appears to have slowed in the mid 2000s. 11 …”

Section: Discussionmentioning

confidence: 99%

“…Regarding variation in practice, we know that performance of cervical computed tomography (CT) among children with TBI younger than 18 years ranges from 0.9 to 59.4% across select children's hospitals. 11 We do not know what this range is for young children with TBI, especially after adjustment for patient characteristics. Regarding differences across types of hospitals, in prior work describing cervical imaging of children younger than 3 years presenting with blunt trauma, Level 1 adult trauma centers and pediatric trauma centers in adult hospitals were more likely to obtain cervical CT than Level 1 pediatric trauma centers in children's hospitals.…”

Section: Introductionmentioning

confidence: 99%

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Hospital Variation in Cervical Spine Imaging of Young Children With Traumatic Brain Injury

Henry

Zonfrillo

French

et al. 2016

Academic Pediatrics

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Objectives Cervical imaging practices are poorly understood in young children with Traumatic Brain Injury (TBI). We therefore sought to: identify child-level and hospital-level factors associated with performance of cervical imaging of children with TBI from falls and abusive head trauma (AHT); and describe across-hospital variation in cervical imaging performance. We hypothesized that imaging decisions would be influenced by hospital volume of young injured children. Methods We performed a retrospective study of children younger than 2 years of age with TBI from 2009-2013 in the Premier Perspective Database. After adjustment for observed patient characteristics, we evaluated variation in advanced cervical imaging (computed tomography or magnetic resonance imaging) in children with AHT and TBI from falls. Results Of 2,347 children with TBI, 18.7% were from abuse, and 57.1% were from falls. Fifteen percent of children with TBI underwent advanced cervical imaging. Moderate or severe head injuries were associated with increased odds of cervical imaging in AHT (OR 7.10; 95% CI 2.75, 18.35) and falls (OR 2.25; 95% CI 1.19, 4.27). There was no association between annual hospital volume of injured children and cervical imaging performance. The adjusted probability of imaging across hospitals ranged from 4.3 to 84.3% in AHT and 3.1 to 39.0% in TBI from falls (P < 0.001). Conclusions These results highlight variation across hospitals in adjusted probability of cervical imaging in AHT (nearly twenty-fold) and TBI from falls (over ten-fold) not explained by observed patient characteristics. This variation suggests opportunities for further research to inform imaging practices.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hospital Variation in Cervical Spine Imaging of Young Children With Traumatic Brain Injury

Henry

Zonfrillo

French

et al. 2016

Academic Pediatrics

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“…However, the increased use of cervical CT has not resulted in an increasing rate of definitive diagnosis. Bennett et al . reported that, during their study period, the rate of diagnoses of CSI in children with head injuries increased, probably because of improved imaging technology.…”

Section: Discussionmentioning

confidence: 96%

“…reported a sensitivity of 98%. The rate was 98%–99% for cervical CT . When cervical radiographs and CT were used together, 100% of cervical injuries could be diagnosed …”

Section: Discussionmentioning

confidence: 99%

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Is spinal computed tomography necessary in pediatric trauma patients?

Eren¹,

Güzey²

2020

Pediatrics International

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Background: To investigate the prevalence of findings of spinal injury on computed tomography (CT) images of pediatric trauma patients and to define indicators for the possible presence of spinal injuries. Methods: Spinal CT for pediatric trauma patients (age ≤ 12 years) over a 2-year period was retrospectively evaluated for the presence of findings suggestive of spinal injury. Results: Of the 773 patients reviewed, 19 (2.4%) showed traumatic spinal lesions on their spinal CT images. These patients were significantly older than those without spinal lesions (mean age 7.9 AE 3.3 years vs 6.1 AE 3.3 years; P = 0.02). The prevalence of spinal trauma was significantly lower in patients aged 0-8 years than in those aged 9-12 years (P = 0.025). Spinal injury was significantly higher in female patients (P = 0.014). Most of the spinal injuries were located at the lumbar and sacral vertebral levels, and most did not cause neurological complications or require surgical treatment. Important indicators of the possible presence of spinal injuries were pain, tenderness, or ecchymosis over the spine, a low Glasgow Coma Scale score (≤12), head injury (for cervical injuries), or intrathoracic injuries and pelvic fractures (for lumbar and sacral injuries). Conclusions: Most spinal CT examinations for the diagnosis of spinal injuries in children did not show positive findings. Thus, many children were exposed to an unnecessary high dose of radiation. New clinical evaluation criteria and indicators should be defined to diagnose spinal injuries and avoid unnecessary radiological examinations.

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