Takeaway
- In this large series of children with suspected cervical spine (C-spine) injury (CSI), none with normal cervical CT had unstable injury on MRI.
- Authors propose algorithm, saying, “These findings support the notion that in the setting of a normal CT, cervical collar removal is safe, and MRI is unnecessary for this purpose.”
Why this matters
- For some obtunded children with normal cervical CT, the Pediatric Cervical Spine Study Group recommends MRI.
- Supporting evidence is low-quality.
- Newer CTs deliver good detail.
- MRI acquisition itself involves risk.
Key results
- C-spine fractures found in 51 children on CT, 56 on MRI.
- Of the 5 with fractures undetected on CT, 1 was unstable; CT had detected ligamentous injury.
- 72.4% (160 children) had normal CT.
- Of those, 76 (47.5%) had stable injury on MRI, mostly ligamentous.
- No child with normal CT was clinically unstable or had unstable injury on MRI.
- 9.5% (21 children) had stable injuries on CT.
- Of those, 4 were deemed unstable on MRI; none required surgical or halo stabilisation.
- Similar results in multiple subgroup analyses.
Study design
- Retrospective single-centre study of children who underwent cervical CT and MRI for suspected C-spine trauma (n=221).
- Outcomes: CT/MRI discordance.
- Funding: None.
Limitations
- Single-centre study.
References
References