title: Utility of plain radiographs and MRI in cervical spine clearance in symptomatic non-obtunded pediatric patients without high-impact trauma.
abstract: OBJECTIVE
  The optimal imaging modality for evaluating cervical spine trauma and optimizing management in the pediatric population is controversial. In pediatric populations, there are no well-established guidelines for cervical spine trauma evaluation and treatment. Currently, there is virtually no literature regarding imaging and management of symptomatic pediatric patients who present with cervical spine trauma without high-impact mechanism. This study aims to establish an optimal imaging strategy for this subgroup of trauma patients.
  
  
  METHODS
  We performed a retrospective review of pediatric patients (aged below 18 years) who were admitted to Monash Medical Centre, Melbourne, Australia between July 2011 and June 2015, who did not suffer a high-impact trauma but were symptomatic for cervical spine injury following cervical trauma. Imaging and management strategies were reviewed and results compared.
  
  
  RESULTS
  Forty-seven pediatric patients were identified who met the inclusion criteria. Of these patients, 46 underwent cervical spine series (CSS) plain radiograph imaging. Thirty-four cases underwent magnetic resonance imaging (MRI) and 9 patients underwent CT. MRI was able to detect 4 cases of ligamentous injury, which were not seen in CSS imaging and was able to facilitate cervical spine clearance in a further two patients whose CSS radiographs were abnormal.
  
  
  CONCLUSIONS
  In this study, MRI has a greater sensitivity and specificity when compared to CSS radiography in a symptomatic pediatric low-impact trauma population. Our data call in to question the routine use of CSS radiographs in children.
authors.affiliation: Department of Neurosurgery, Monash Medical Centre, 246 Clayton Rd, Melbourne, Clayton, VIC 3168, Australia. justinmurraymoore@gmail.com.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Moore
authors.affiliation: Department of Neurosurgery, Monash Medical Centre, 246 Clayton Rd, Melbourne, Clayton, VIC 3168, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hall
authors.affiliation: Department of Pediatric Imaging, Monash Medical Centre, Melbourne, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Ditchfield
authors.affiliation: Department of Neurosurgery, Monash Medical Centre, 246 Clayton Rd, Melbourne, Clayton, VIC 3168, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Xenos
authors.affiliation: Department of Neurosurgery, Monash Medical Centre, 246 Clayton Rd, Melbourne, Clayton, VIC 3168, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Danks
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000000981:diagnostic imaging* / Q000473:pathology*
keywords: Cervical spine; Imaging; Low impact; Management; Pediatric; Trauma