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Using CT of the Cervical Spine for Early Evaluation of Pediatric Patients with Head Trauma

¹ Department of Pediatrics, CB 7220, 7701A 7th Floor, UNC Children's Hospital, University of North Carolina, 101 Manning Dr., Chapel Hill, NC 27599-7200.
² School of Medicine, University of North Carolina, Chapel Hill, NC 27599-7200.
³ Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7200.
⁴ Present address: Department of Radiology, Martha Jefferson Hospital, 459 Locust Ave., Charlottesville, VA 22902.
⁵ Trauma Outreach, University of North Carolina, Chapel Hill, NC 27599-7200.

OBJECTIVE. The purpose of this study was to assess the effectiveness of CT of the cervical spine in addition to radiography in pediatric patients with suspected head trauma at the time of the CT head examination.

MATERIALS AND METHODS. We identified 63 pediatric patients admitted to the emergency department who had head trauma and who underwent both head CT and neck radiography. Those who underwent CT of the cervical spine at the time of the head CT examination during their initial evaluation were compared for demographics, clinical status, mechanism of injury, and number of excess radiographs (number required by protocol minus number of films obtained) required to evaluate the cervical spine with those patients who did not undergo early CT of the cervical spine.

RESULTS. Twenty-one patients (33%) underwent cervical spine CT at the time of the head CT examination. The number of excess radiographs differed significantly between these patients (2.1 ± 2.6 vs 3.6 ± 2.7, p = 0.04) and the comparison group. Patients who did not undergo early CT for whom excess radiographs were obtained had the following characteristics: they were older than 8 years (p = 0.03), were unrestrained in a motor vehicle crash (p = 0.04), had a Glasgow coma score of 13-15 (p = 0.01), and were intubated (p = 0.02).

CONCLUSION. The number of repeated radiographs required to ascertain that the cervical spine is free of injury after suspected head trauma is significantly fewer when initial CT of the neck is performed at the time of head CT examination. Including cervical spine CT in trauma protocols for subgroups of children with head injuries may lead to more effective clearance of the pediatric cervical spine.

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This article has been cited by other articles:

				S. Ehara, C. J. Chung, and H. T. Keenan Limitations of CT Screening of Cervical Spine Injuries in Children Am. J. Roentgenol., August 1, 2002; 179(2): 533 - 533. [Full Text] [PDF]