Cervical spine computed tomography in Pediatric cervical spine injury [Neurosurgery Wiki]

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====== Cervical spine computed tomography in Pediatric cervical spine injury ======

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Silva et al. 
((Silva CT, Doria AS, Traubici J, et al. Do additional views improve the diagnostic performance of cervical spine radiography in pediatric trauma?))
compared the sensitivity of the lateral [[cervical spine radiography]] image alone with additional images using CT as a reference standard and found that the additional images did not increase the sensitivity (73%; 95% CI, 50–89%) and marginally decreased specificity (92% vs 91%). The sensitivity of 73% was considered barely acceptable for a screening study. Other investigations into potential advantages of additional images in the radiographic evaluation of pediatric CSI concluded routine anteroposterior and lateral views correctly identified CSI in 87% of children < 9 years old but that that the odontoid view was not helpful in making the diagnosis of CSI ((Buhs C, Klein M, Farmer D. The pediatric trauma c-spine: is the “odontoid” view necessary?)).
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[[Cervical spine computed tomography]] was overutilized in a trauma center. There is a low positive CSCT scan rate among adolescent patients, which aligns with the current literature. All patients with positive CSCT passed NEXUS criteria suggesting that a quality improvement project focusing on the use of the NEXUS criteria to assess the risk of cervical spine injury could potentially reduce the use of CSCT scans by nearly 40%
((Sharma B, Kolousek A, Lian B, Koganti D, Smith RN, Sola R Jr. Cervical Spine Computed Tomography in Adolescent Blunt Trauma Patients: Are They Being Overutilized? J Surg Res. 2023 Feb;282:155-159. doi: 10.1016/j.jss.2022.09.016. Epub 2022 Oct 21. PMID: 36279708.))
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In [[pediatric traumatic brain injury]], the use of cervical spine radiographs alone decreased between 2001 (47%) and 2011 (23%), with an annual decrease of 2.2% (95% [[confidence interval]] [CI], 1.1%-3.3%), and was largely replaced by increased use of [[CT]], with or without radiographs (8.6% in 2001 and 19.5% in 2011, with an annual increase of 0.9%; 95% CI, 0.1%-1.8%). A total of 2545 children received cervical spine CT despite being discharged alive from the hospital in less than 72 hours, and 1655 of those had a low-risk mechanism of injury.

The adoption of CT clearance of the cervical spine in adults seems to have influenced the care of children with [[traumatic brain injury]] TBI, despite concerns about radiation exposure
((Bennett TD, Bratton SL, Riva-Cambrin J, Scaife ER, Nance ML, Prince JS, Wilkes
J, Keenan HT. Cervical Spine Imaging in Hospitalized Children With Traumatic
Brain Injury. Pediatr Emerg Care. 2015 Mar 23. [Epub ahead of print] PubMed PMID:
25803749.
)).

CT is superior to radiography in detecting [[cervical spine fracture]]s. CT dose reduction, although important, should not be so excessive that soft-tissue contrast is lost because the only clues to ligamentous injury in the absence of fractures might be hematoma of the epidural space and edema of the regional soft tissues. General dose parameters should be a kilovoltage of ≤ 120 kVp and tube current ranging from 60 to 120 mAs, depending on the age and size of the child and could be lowered further depending on image quality. Coronal and sagittal reconstructed imaging should be performed routinely. Given the proclivity for ligamentous injury in infants and the insensitivity of CT to ligamentous injury, it is debatable whether CT should be performed at all for suspected CSI in children under 5 years old. If conventional radiographs suggest an abnormality, CT through the area of concern may allow clearance of the cervical spine and limit the radiation exposure
((Egloff AM, Kadom N, Vezina G, Bulas D. Pediatric cervical spine trauma imaging: a practical approach. Pediatr Radiol 2009; 39:447–456)).