It was shown that MRI facilitates the ability to classify thoracolumbar fractures in adults and children [27,28]. Sacral fractures account for only 0.16% of all pediatric trauma patients [3]. In a retrospective study of 89 patients, only 5% sacral fractures were found, all of which were Denis zone 1 fractures [3], which are located lateral to the neural elements and commonly involve the sacral alae [29]. Adequate radiographs still miss 35% of sacral fractures; therefore, CT and MRI are superior to radiographs in the diagnosis of sacral fractures [29]. Imaging plays a crucial role in the detection and classification of traumatic spinal injuries in children. Failure to identify patients with an unstable spine injury and potential spinal cord compromise can lead to increased patient morbidity [7]. Conversely, the ability to identify patients without spinal injury can avoid unnecessary imaging and aids in the decision to discontinue spinal precaution protocols, which can result in skin breakdown and ulceration when used over prolonged periods of time [7]. Discussion of Procedures by Variant Variant 1: Child, 3 to 16 years of age, acute cervical spine trauma, meets low risk criteria (based on PECARN or NEXUS). Initial imaging. Radiography Cervical Spine The routine radiograph of the cervical spine in children with head trauma has a very low yield; in fact, the two cases of cervical injury in a cohort of 905 infants (0.02%) were due to an abusive trauma mechanism [4] (based on PECARN or NEXUS in Appendix 1). CT Cervical Spine In adult populations, CT is the superior screening modality for patients who are at very high risk for cervical spine injury. In children, there is no evidence in favor of replacing screening radiographs with CT in children at low risk for cervical spine injury [30].
Suspected Spine Trauma Child PCAs. It was shown that MRI facilitates the ability to classify thoracolumbar fractures in adults and children [27,28]. Sacral fractures account for only 0.16% of all pediatric trauma patients [3]. In a retrospective study of 89 patients, only 5% sacral fractures were found, all of which were Denis zone 1 fractures [3], which are located lateral to the neural elements and commonly involve the sacral alae [29]. Adequate radiographs still miss 35% of sacral fractures; therefore, CT and MRI are superior to radiographs in the diagnosis of sacral fractures [29]. Imaging plays a crucial role in the detection and classification of traumatic spinal injuries in children. Failure to identify patients with an unstable spine injury and potential spinal cord compromise can lead to increased patient morbidity [7]. Conversely, the ability to identify patients without spinal injury can avoid unnecessary imaging and aids in the decision to discontinue spinal precaution protocols, which can result in skin breakdown and ulceration when used over prolonged periods of time [7]. Discussion of Procedures by Variant Variant 1: Child, 3 to 16 years of age, acute cervical spine trauma, meets low risk criteria (based on PECARN or NEXUS). Initial imaging. Radiography Cervical Spine The routine radiograph of the cervical spine in children with head trauma has a very low yield; in fact, the two cases of cervical injury in a cohort of 905 infants (0.02%) were due to an abusive trauma mechanism [4] (based on PECARN or NEXUS in Appendix 1). CT Cervical Spine In adult populations, CT is the superior screening modality for patients who are at very high risk for cervical spine injury. In children, there is no evidence in favor of replacing screening radiographs with CT in children at low risk for cervical spine injury [30].