Pediatric Trauma Society

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Single-Lateral Cervical Radiograph is Equivalent to Multiple Views.
Erika Lindholm, MD1; Archana Malik, MD1; Darshan Parikh, BA2; Tara Mamdouhi, BA2; Lauren Alper, BA2; Teerin Meckmongkol, MD1; Sean Ciullo, MD1; L. Grier Arthur, MD1; Rajeev Prasad, MD1; Martin Herman, MD1; Harsh Grewal, MD1
1St. Christopher's Hospital for Children, Philadelphia, PA; 2Drexel University, Philadelphia, PA

Background: Cervical spine injuries (CSI) are rare within the pediatric population. Due to the significant consequences of missed injuries, children often get excessive imaging. In attempt to decrease imaging, we reviewed abnormal cervical radiographs (XR) to determine if diagnosis could be made using single-lateral cervical radiograph (LAT). Futhermore, we reviewed cervical computed tomography (CT) and magnetic resonance imaging (MRI) to ensure there were no missed injuries.

Methods: Charts of trauma patients with abnormal XR findings followed by confirmatory CT or MRI between 2012 and 2017 were reviewed. All abnormal imaging on XR was compared to LAT. In addition, all abnormal CT and MRI were reviewed to ensure there were no false negative XR.

Results: A total of 3735 XR were performed with 26 abnormal. 100% of injuries were visualized on LAT. Confirmatory imaging found 13(50%) were overcalls and 13(50%) were correct. Secondary analysis of CT identified 12 injuries with prior XR; 8/12 LAT identifying the injury and 4/12 overcalls on CT. Secondary analysis of MRI identified 9 injuries with prior XR; 5/9 LAT identifying the injury. The 4 missed injuries were ligamentous.

Conclusions: XR is commonly performed when evaluating CSI. In our population, LAT was equivalent to a multiple view XR. On secondary review, the only false negative LAT reports were due to ligamentous injuries. This data suggests limiting exposure to a single view radiograph.

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