The battle of the diagnostics

New study compares CT scans with MRIs for cervical spine injury detection in unconscious paediatric patients

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Definitive diagnosis of cervical spine injuries in unconscious paediatric patients can be difficult. Researchers at KAIMRC have conducted a retrospective cohort study evaluating effective diagnosis by computed tomography (CT) and magnetic resonance imaging (MRI).

Children involved in motor vehicle accidents, sports injuries and falls are susceptible to cervical spine injury. If left untreated, cervical spine injury can lead to neurologic deterioration, paralysis and death, so medical professionals must immediately check for the possibility of cervical spine injury in paediatric patients following a traumatic event.

To compare diagnostic methods, researchers, started by observing all patients admitted to a level I trauma centre built to serve Saudi Arabian national guards and their families inside King Abdulaziz Medical City (KAMC) between January 2005 and July 2018. 

For their study, they looked at 62 unconscious paediatric cases of patients aged 15 or under with suspected cervical spine injury. They collected data that includes age, gender, injury mechanism and severity, method used to detect cervical spine injury, radiological findings, clearance time and patient outcome. 

After analysis, the researchers found that CT performed quite well in the initial assessment of injury. CT scans, according to the study, accurately identified 28 children with cervical spine abnormalities, such as straightening, fractures, hematomas or subluxation (misalignment of the vertebrae). 

However, the diagnostic method was not very reliable when it came to problems related to soft tissues and ligaments. MRI was able to detect five cases with abnormalities that were not previously detected by CT. The abnormalities varied in severity from mild ligamentous to unstable craniocervical ligamentous injury. 

The paediatric patients’ average age was eight. Approximately three quarters of them were male. The most common cause of injury was road traffic accidents (59.7%), followed by pedestrian accidents (21%) and falls (14.5%). The patients stayed in the intensive care unit between 18 and 29 days, respectively. 

“Most of these were not managed surgically, except for one case,” said Saud Al-Sarheed, one of the co-authors of the paper. “This translates to 84.8% and 100% CT sensitivity and specificity, respectively.” 

Although MRI is more expensive than CT the researchers concluded that it was cost-efficient and shortened the patients’ recovery time.

References

  1.  Al-Sarheed, S., et al. Cervical spine clearance in unconscious pediatric trauma patients: a level l trauma center experience. Child’s Nervous System 36, 811–817 (2020).| article

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