title: Role of oblique radiographs in blunt pediatric cervical spine injury.
abstract: OBJECTIVE
  To determine the usefulness of oblique cervical spine radiography (OCSR) in the management of children who have sustained blunt cervical spine injury, particularly if OCSR is abnormal when no acute abnormalities are shown on standard cervical spine radiography (SCSR).
  
  
  METHODS
  We carried out a blinded radiographic review of 109 patients younger than 16 years evaluated at an academic pediatric trauma center and a community hospital between July 1990 and December 1997. All patients had SCSR (anteroposterior/lateral views) and OCSR performed for a trauma-related event within 7 days of injury.
  
  
  RESULTS
  In 105 patients (96.3%), radiographic impression after review of SCSR and OCSR did not differ from that after SCSR review alone (95% confidence interval 90.9%, 99.0%). Radiographic impression was revised after OCSR review in 4 patients, all with equivocal findings on SCSR, to normal in three patients and abnormal in one patient (subluxation). Of 78 patients without acute abnormalities on SCSR, no patient had acute abnormalities on OCSR (95% CI, 0-3.8%).
  
  
  CONCLUSIONS
  In our series of 109 children who underwent acute radiographic evaluation of blunt cervical spine trauma, oblique views were unlikely to be abnormal if no acute abnormalities were evident on standard anteroposterior and lateral radiographs. Although few patients are likely to benefit from the addition of these views on a routine basis, a useful role for oblique cervical spine radiographs in detecting cervical spine injury in children cannot be excluded based on the results of this study.
authors.affiliation: Division of Emergency Medicine, Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA. meralston@mar.med.navy.mil
authors.forename: Mark E
authors.initials: ME
authors.lastname: Ralston
authors.forename: Kirsten
authors.initials: K
authors.lastname: Ecklund
authors.forename: John B
authors.initials: JB
authors.lastname: Emans
authors.forename: Susan B
authors.initials: SB
authors.lastname: Torrey
authors.forename: Mary Christine
authors.initials: MC
authors.lastname: Bailey
authors.forename: Sara A
authors.initials: SA
authors.lastname: Schutzman
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D004204:Joint Dislocations / Q000175:diagnosis / Q000000981:diagnostic imaging; D008297:Male; D011859:Radiography / Q000379:methods; D012189:Retrospective Studies; D015983:Selection Bias; D016037:Single-Blind Method; D016103:Spinal Fractures / Q000175:diagnosis / Q000000981:diagnostic imaging; D013124:Spinal Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging*