Diagnostic Yield of Axial Computed Tomography Scans for Pediatric Axial Skeletal Injuries.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
01 Jul 2021
01 Jul 2021
Historique:
entrez:
8
6
2021
pubmed:
9
6
2021
medline:
10
7
2021
Statut:
ppublish
Résumé
Retrospective cohort study. To evaluate the diagnostic yield of computed tomography (CT) imaging of the axial skeleton in pediatric patients evaluated a level I trauma center. CT imaging has become ubiquitous in the assessment of axial skeletal injuries in trauma patients. This is a retrospective study from one Level I trauma center of patients undergoing CT imaging during pediatric trauma assessment. Medical records of pediatric trauma patients 18-year old and younger who underwent axial skeletal CT imaging from 2013 to 2015 were evaluated. The following were assessed: mechanism of injury, age, sex, race/ethnicity, presence of fracture, management of fracture. A total of 831 patients were assessed, there were 355 (42.7%) females and 476 males (57.3%) with an average age of 15.4 (2 mo-18 yrs). 588 (70.8%) were White, 164 (19.7%) were African-American, 12 (1.4%) were Asians, 67 (8.1%) other, and 46 (5.5%) identified as Hispanic. There were 45 patients (5.4%) who sustained 52 fractures. Common mechanisms were motor vehicle accidents (MVA) 28%, sports injuries (18%), and fall from height (15%). 35.9% of fractures were identified on plain radiographs. Nine injuries were treated surgically (one cervical, two thoracic, two lumbar, and four pelvic); three of these were identified on radiographs. From the 14 patients with cervical spine fractures none were detected on radiographs. In this large series of 831 pediatric patients undergoing axial CT imaging, the rate of axial fractures was 5.4%. The majority of these fractures were managed non-surgically. Only 35.9% of fractures were identified on radiographs.Level of Evidence: 3.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective cohort study.
OBJECTIVE
OBJECTIVE
To evaluate the diagnostic yield of computed tomography (CT) imaging of the axial skeleton in pediatric patients evaluated a level I trauma center.
SUMMARY OF BACKGROUND DATA
BACKGROUND
CT imaging has become ubiquitous in the assessment of axial skeletal injuries in trauma patients.
METHODS
METHODS
This is a retrospective study from one Level I trauma center of patients undergoing CT imaging during pediatric trauma assessment. Medical records of pediatric trauma patients 18-year old and younger who underwent axial skeletal CT imaging from 2013 to 2015 were evaluated. The following were assessed: mechanism of injury, age, sex, race/ethnicity, presence of fracture, management of fracture.
RESULTS
RESULTS
A total of 831 patients were assessed, there were 355 (42.7%) females and 476 males (57.3%) with an average age of 15.4 (2 mo-18 yrs). 588 (70.8%) were White, 164 (19.7%) were African-American, 12 (1.4%) were Asians, 67 (8.1%) other, and 46 (5.5%) identified as Hispanic. There were 45 patients (5.4%) who sustained 52 fractures. Common mechanisms were motor vehicle accidents (MVA) 28%, sports injuries (18%), and fall from height (15%). 35.9% of fractures were identified on plain radiographs. Nine injuries were treated surgically (one cervical, two thoracic, two lumbar, and four pelvic); three of these were identified on radiographs. From the 14 patients with cervical spine fractures none were detected on radiographs.
CONCLUSION
CONCLUSIONS
In this large series of 831 pediatric patients undergoing axial CT imaging, the rate of axial fractures was 5.4%. The majority of these fractures were managed non-surgically. Only 35.9% of fractures were identified on radiographs.Level of Evidence: 3.
Identifiants
pubmed: 34100840
doi: 10.1097/BRS.0000000000003932
pii: 00007632-202107010-00009
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
867-873Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Références
Miglioretti DL, Johnson E, Williams A, et al. The use of computed tomography in pediatric and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 2013; 167:700–707.
Jimenez RR, DeGuzman MA, Shiran S, et al. CT versus plain radiographs for evaluation of c-spine injury in young children: do benefits outweigh risks? Pediatr Radiol 2008; 38:635–644.
Brenner D, Elliston C, Hall E, et al. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 2001; 176:289–296.
Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med 2007; 357:2277–2284.
Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med 2003; 349:2510–2518.
Parisini P, Di Silvestre M, Greggi T. Treatment of spinal fractures in children and adolescents: long-term results in 44 patients. Spine (Phila Pa 1976) 2002; 27:1989–1994.
Clark P, Letts M. Trauma to the thoracic and lumbar spine in the adolescent. Can J Surg 2001; 44:337–345.
Anderson RC, Scaife ER, Fenton SJ, et al. Cervical spine clearance after trauma in children. J Neurosurg 2006; 105:361–364.
Cirak B, Ziegfeld S, Knight VM, et al. Spinal injuries in children. J Pediatr Surg 2004; 39:607–612.
Hofbauer M, Jaindl M, Höchtl LL, et al. Spine injuries in polytraumatized pediatric patients: characteristics and experience from a Level I trauma center over two decades. J Trauma Acute Care Surg 2012; 73:156–161.
Pang D, Pollack IF. Spinal cord injury without radiographic abnormality in children–the SCIWORA syndrome. J Trauma 1989; 29:654–664.
Sayama C, Chen T, Trost G, et al. A review of pediatric lumbar spine trauma. Neurosurg Focus 2014; 37:E6.
Kim C, Vassilyadi M, Forbes JK, et al. Traumatic spinal injuries in children at a single level 1 pediatric trauma centre: report of a 23-year experience. Can J Surg 2016; 59:205–212.
Srinivasan V, Jea A. Pediatric thoracolumbar spine trauma. Neurosurg Clin N Am 2017; 28:103–114.
Daniels AH, Sobel AD, Eberson CP. Pediatric thoracolumbar spine trauma. J Am Acad Orthop Surg 2013; 21:707–716.
Kuppermann N, Holmes JF, Dayan PS, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 2009; 374:1160–1170.
Pinto A, Berritto D, Russo A, et al. Traumatic fractures in adults: missed diagnosis on plain radiographs in the Emergency Department. Acta Biomed 2018; 89:111–123.
Hale AT, Alvarado A, Bey AK, et al. X-ray vs. CT in identifying significant C-spine injuries in the pediatric population. Childs Nerv Syst 2017; 33:1977–1983.