title: Do not waste your time: straight to magnetic resonance imaging for pediatric burners and stingers.
abstract: BACKGROUND
  Permanent neurologic injury in pediatric patients with burner and stinger syndrome (BSS) is unlikely. This study aims to assess the feasibility of clinical observation without extensive radiologic workup in this selective population.
  
  
  METHODS
  A retrospective study was conducted of patients aged younger than 18 years evaluated at a level I trauma center from 2012 to 2014. Patients were grouped according to positive deficit (PD) or negative deficit (ND) upon physical examination. Demographics, clinical findings, and outcomes were analyzed.
  
  
  RESULTS
  Thirty patients (ND, n = 14; PD, n = 16) were evaluated for BSS, most often as a result of injurious football tackle. Age and length of stay were similar between groups. Injury Severity Score was lower in the ND group than the PD group (1.6 ± 1.2 vs 3.8 ± 3.1, respectively; P< .05). Cervical computed tomography was performed on 11 patients (78.6%) in the ND group and 15 patients (93.8%) in the PD group at considerable added cost, with only 1 positive result in the ND group and none in the PD group. Magnetic resonance imaging (MRI) revealed 2 positive findings in each group, and no surgical interventions were indicated. Ten ND (71.4%) and 12 PD (75%) patients reported complete resolution of symptoms at discharge (P> .05).
  
  
  CONCLUSIONS
  Children presenting with BSS experience temporary symptoms that resolve without surgical intervention. Magnetic resonance imaging identified more injuries than computed tomographic imaging; therefore, we suggest that management for BSS should include observation, serial neurologic examinations, and MRI evaluation as appropriate.
authors.affiliation: Division of Trauma and Acute Care Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: Richard.sola@carolinashealthcare.org.
authors.forename: Richard
authors.initials: R
authors.lastname: Sola
authors.affiliation: Division of Trauma and Acute Care Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: Ashley.christmas@carolinashealthcare.org.
authors.forename: A Britton
authors.initials: AB
authors.lastname: Christmas
authors.affiliation: Division of Trauma and Acute Care Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: Bradley.thomas@carolinashealthcare.org.
authors.forename: Bradley W
authors.initials: BW
authors.lastname: Thomas
authors.affiliation: Division of Trauma and Acute Care Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: peter.fischer@carolinashealthcare.org.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Fischer
authors.affiliation: Division of Trauma and Acute Care Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: Eubanksg13@students.ecu.edu.
authors.forename: Grayson C
authors.initials: GC
authors.lastname: Eubanks
authors.affiliation: Division of Trauma and Acute Care Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: Nora.raynor@carolinashealthcare.org.
authors.forename: Nora E
authors.initials: NE
authors.lastname: Raynor
authors.affiliation: Division of Trauma and Acute Care Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. Electronic address: Ronald.sing@carolinashealthcare.org.
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Sing
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000150:complications / Q000175:diagnosis*; D020516:Brachial Plexus Neuropathies / Q000175:diagnosis* / Q000209:etiology; D002648:Child; D003657:Decision Making; D003937:Diagnosis, Differential; D005240:Feasibility Studies; D006801:Humans; D015601:Injury Severity Score; D008279:Magnetic Resonance Imaging / Q000379:methods; D013577:Syndrome; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis*