Cervical Spine Imaging - An Important Adjunct in Children with Abusive Head Trauma
*Heather Ann Hartman, *Peter F. Ehrlich, *Arul S. Thirumoorthi
University of Michigan, Ann Arbor, MI
Introduction: Non-accidental trauma (NAT) is a major cause of morbidity and mortality in children. A computed tomography scan of the head (CTH) for abusive head trauma (AHT) is mandated in NAT evaluations for infants less than 6 months, children who are developmentally delayed, or who have altered mental status. Cervical spine injuries such a ligamentous injuries are subtle in the pediatric trauma population. However, limited data exists about the relationship of cervical spine injuries in patients who suffer abuse head trauma. We hypothesize that children who had positive finding on CT head would have a higher risk of cervical spine injuries. Methods: This a retrospective chart review of patients at a level 1 pediatric trauma center who underwent CTH for NAT workup. We reviewed whether the CT head was positive, whether they had additional imaging of the cervical spine, and what those finding were. Results: During the study 60 of 114 children underwent CTH as part of a NAT evaluation. There were 41 males and 19 females with a median age was 3.3m (0.2-52.1). Reason for CTH was age <6mo in 41, developmental delay in 1, altered mental status in 8, and high index of suspicion of NAT in 10. 51/60 (85%) of CTHs identified a cranial injury. Thirty-six underwent additional imaging (9 CT spine, 14 MRI spine, 13 both).10 of 36 (28%) were found to have c-spine injury, 8 of which were identified on MRI. These injuries included ligamentous (3), hematoma (4), cord (1), and vertebral body (2).
Conclusions: In this pilot study we found that 28% of children with AHT had an associated c-spine injury. Our data suggests that imaging for cervical spine injuries should be considered in patients who had a positive CTH scan. Larger prospective studies are needed to confirm this observation.
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