Written by Carmen Wolfe
Spoon Feed
Limited sequence MRI is adequate to identify clinically-significant unstable cervical spine injuries in pediatric blunt trauma patients.
MRIs are a pain in the neck…
While rare, pediatric cervical spine injuries can be devastating. After high-energy blunt trauma, children are susceptible to ligamentous injuries, and computed tomography may not definitively rule out injury. Current practice may include MRI of the cervical spine; however, this is time-consuming and often requires sedation. Could a limited-sequence MRI (LSMRI) provide a more efficient route to definitive diagnosis?
This retrospective study across ten pediatric trauma centers evaluated the ability of LSMRI to detect unstable cervical spine injuries. Authors evaluated all pediatric patients (N=2,663) admitted after blunt trauma who had a cervical spine MRI. Prevalence of unstable cervical spine injury was high (N=301). Radiologists (who had access to the previous MRI reports) viewed only fluid-sensitive sequences from these studies to determine if the injuries identified on full sequence MRI would have been found with LSMRI. Sensitivity and negative predictive value were found to be > 99% for evaluation of all injuries and 100% for unstable injuries.
Despite the retrospective design and potential bias of the reviewing radiologists, this well-executed study supports the creation of thoughtful protocols for implementation of LSMRI of the cervical spine in pediatric trauma.
How will this change my practice?
I will encourage my institution to adopt limited sequence MRI protocols for pediatric blunt trauma patients with unreliable neurologic exams who need further cervical spine evaluation. Given the faster acquisition times, decreased need for anesthesia, and high sensitivity, this seems like an easy sell for better patient care.
Editor’s note: There is evidence that no clinically significant injuries are missed when a child has a negative CT. If a CT has been performed and is normal and the child’s neurological exam is normal, I will clear the collar. ~Clay Smith
Source
The Sensitivity of Limited-Sequence MRI in Identifying Pediatric Cervical Spine Injury: A Western Pediatric Surgery Research Consortium Multicenter Retrospective Cohort Study. J Trauma Acute Care Surg. Published online March 25, 2024.
