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Cervical Spine MRI Utilization for Identification of Cervical Spine Injuries Among Children With Non-Accidental Trauma
Amina M. Bhatia, MD, MS, Ahyuda Oh, MPH, PhD and Joshua J. Chern, MD, PhD, Children's Healthcare of Atlanta, Emory University, Atlanta GA

Abstract: Aim: To determine if a practice guideline recommending cervical spine magnetic resonance imaging (MRI) in children with non-accidental trauma (NAT) head injury significantly impacted treatment and outcomes. Methods: Pediatric patients with suspected or confirmed NAT from 2009-2014 were identified from a prospectively maintained database at a single, pediatric healthcare system. Event and outcome data were retrospectively collected from electronic medical record. In 2012, a new pathway was instituted to consider cervical spine MRI for patients with suspected and confirmed NAT. For the present comparative study, the patients were divided into pre- and post-guideline implementation groups (pre-:2009-2011 vs. post-: 2012-2014). Predictor variables and outcomes were compared using chi-square analysis. Results: A total of 503 patients were identified. Compared with patients in the pre-guideline group (n=249), those in the post-guideline (n=254) were more likely to undergo cervical spine MRI (pre-, 2.8% vs. post-, 33.1%, p-value< 0.05). There was a significant increase in cervical collar application from 16.5% to 27.6% after introducing the guideline (p-value <0.05), and more patients were discharged home with cervical collar immobilization. One patient required surgical cervical stabilization in the post-guideline group. Mortality, presence of operative and non-operative cranial injury, and other clinical factors were not significantly different between the two groups. Conclusions: A heightened awareness of potential cervical spine injury in this patient group had increased the use of cervical spine MRI and soft-collar immobilization. However, severe cervical spine injury remains rare and may not be effectively detected by increased use of MR imaging.

Objective: The listener will be able to discuss the impact of an NAT imaging pathway on patient treatment and outcomes.

Objective Content: An NAT-pathway in head injured children with NAT resulted in increased utilization of MRI but did not significantly impact surgical treatment or outcomes.

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