title: Utility of magnetic resonance imaging in diagnosing cervical spine injury in children with severe traumatic brain injury.
abstract: BACKGROUND
  Evaluation of children for cervical spine injuries (CSIs) after blunt trauma is complicated, particularly if the patient is unresponsive because of severe traumatic brain injury. Plain radiography and computed tomography (CT) are commonly used, but CT combined with magnetic resonance imaging (MRI) is still considered the gold standard in CSI detection. However, MRI is expensive and can delay cervical clearance. The purpose of this study is to determine the added benefit of MRI as an adjunct to CT in the clearance of children with severe head trauma.
  
  
  METHODS
  We performed a retrospective chart review of pediatric head trauma patients admitted to the pediatric intensive care unit at St. Louis Children's Hospital from 2002 to 2012. Patients who received both cervical spine CT and MRI and presented with a Glasgow Coma Scale score of 8 or lower were included in the study. Imaging was analyzed by two pediatric trauma subspecialists and classified as demonstrating "no injury," "stable injury," or "unstable injury." Results were compared, and discrepancies between CT and MRI findings were noted.
  
  
  RESULTS
  A total of 1,196 head-injured children were admitted to the pediatric intensive care unit between January 2002 and December 2012. Sixty-three children underwent CT and MRI and met Glasgow Coma Scale criteria. Seven children were identified with negative CT and positive MRI findings, but none of these injuries were considered unstable by our criteria. Five children were determined to have unstable injuries, and all were detected on CT.
  
  
  CONCLUSIONS
  The results of this study suggest that MRI does not detect unstable CSIs in the setting of negative CT imaging. Given the limited patient population for this study, further and more extensive studies investigating the utility of MRI in the head-injured pediatric patient are warranted.
  
  
  METHODS
  Diagnostic and care management study, level IV.
authors.affiliation: From the Washington University in St. Louis School of Medicine (D.Q., J.R.L., M.K., J.P., J.C.L.) St. Louis, Missouri; St. Louis Children's Hospital (M.K., J.P.), St. Louis, Missouri; Nationwide Children's Hospital and the Ohio State University College of Medicine (J.R.L., J.C.L.), Columbus, Ohio.
authors.forename: David
authors.initials: D
authors.lastname: Qualls
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Leonard
authors.forename: Martin
authors.initials: M
authors.lastname: Keller
authors.forename: Jose
authors.initials: J
authors.lastname: Pineda
authors.forename: Julie C
authors.initials: JC
authors.lastname: Leonard
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D002574:Cervical Vertebrae / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008279:Magnetic Resonance Imaging; D008297:Male; D064847:Multimodal Imaging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000150:complications / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis*