Although MRI with short-term T1 inversion recovery (STIR) sequencing has been widely adopted in the clearance of cervical spine in adults who have sustained trauma, its applicability for cervical spine clearance in pediatric trauma patients remains unclear. The authors sought to review a Level 1 trauma center's experience using MRI for posttraumatic evaluation of the cervical spine in pediatric patients.
A pediatric trauma database was retrospectively queried for patients who received an injury warranting radiographic imaging of the cervical spine and had a STIR-MRI sequence of the cervical spine performed within 48 hours of injury between 2002 and 2011. Demographic, radiographic, and outcome data were retrospectively collected through medical records.
Seventy-three cases were included in the analysis. The mean duration of follow-up was 10 months (range 4 days–7 years). The mean age of the patients at the time of trauma evaluation was 8.3 ± 5.8 years, and 65% were male. The majority of patients were involved in a motor vehicle accident. In 70 cases, the results of MRI studies were negative, and the patients were cleared prior to discharge with no clinical suggestion of instability on follow-up. In 3 cases, the MRI studies had abnormal findings; 2 of these 3 patients were cleared with dynamic radiographs during the same admission. Only 1 patient had an unstable injury and required surgical stabilization. The sensitivity of STIR MRI to detect cervical instability was 100% with a specificity of 97%. The positive predictive value was 33% and the negative predictive value was 100%.
Although interpretation of our results are diminished by limitations of the study, in our series, STIR MRI in routine screening for pediatric cervical trauma had a high sensitivity and slightly lower specificity, but may have utility in future practices and should be considered for implementation into protocols.
Abbreviations used in this paper:GCS = Glasgow Coma Scale; MRI = magnetic resonance imaging (used in this study to refer specifically to STIR sequences); STIR = short T1 inversion recovery.
BrockmeyerDLRagelBTKestleJR: The pediatric cervical spine instability study. A pilot study assessing the prognostic value of four imaging modalities in clearing the cervical spine for children with severe traumatic injuries. Childs Nerv Syst28:699–7052012
HoffmanJRMowerWRWolfsonABToddKHZuckerMI: Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med343:94–992000