title: A New Paradigm for the Management of Thoracolumbar Pediatric Spine Traumas.
abstract: OBJECTIVE
  The transient breath holding sign (TBHS) is a clinical sign often associated with magnetic resonance imaging (MRI) spine traumatic lesions. The aims of this study were to prospectively evaluate the TBHS in the detection of thoracolumbar lesions in a large cohort of children and to establish a comprehensive strategy on the use of MRI in spine traumas in children.
  
  
  METHODS
  All conscious 5- to 16-year-old patients admitted for a spine trauma in our institution were prospectively included in the study. All patients were asked for the TBHS and underwent a full spine MRI. Sensitivity and specificity of the TBHS were derived from the confusion matrix. All MRI lesions were analyzed and classified.
  
  
  RESULTS
  One hundred ninety-eight patients were included. The sensitivity of the TBHS was 92%, the specificity was 83%, the positive predictive value was 83%, and the negative predictive value was 91%. The x-rays missed 67% of the vertebrae injured in the MRI. The MRI lesions consisted in an upper end plate injury, in the sagittal plane only, in 90% of the cases. The vertebral canal and the spinal cord were never injured.
  
  
  CONCLUSIONS
  This study confirms that the TBHS is a relevant clinical tool that should be added in the routine questionnaire after any trauma at admission. Magnetic resonance imaging should be restricted to patients with a TBHS positive at admission. A single T2 Short T1 Inversion Recovery (STIR) sagittal sequence seems sufficient to make the diagnosis and could replace the use of standard x-rays in pediatric spine traumas.
authors.affiliation: From the Pediatric Orthopedic Department, Grenoble University Hospital, Joseph Fourier University, Grenoble, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Courvoisier
authors.forename: Baptiste
authors.initials: B
authors.lastname: Belvisi
authors.forename: Romain
authors.initials: R
authors.lastname: Faguet
authors.forename: Ahmad
authors.initials: A
authors.lastname: Eid
authors.forename: Emeline
authors.initials: E
authors.lastname: Bourgeois
authors.forename: Jacques
authors.initials: J
authors.lastname: Griffet
mesh_terms: D000293:Adolescent; D062485:Breath Holding; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D005260:Female; D050815:Fractures, Compression / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000175:diagnosis*; D013124:Spinal Injuries / Q000145:classification / Q000175:diagnosis* / Q000628:therapy