Exceptional indications may exist for patients with contraindications to MRI and in whom impending cord compression is suspected [90]. Summary of Recommendations Variant 1: Imaging is not recommended for the initial imaging of children 3 to 16 years of age with acute cervical spine trauma that meets low risk criteria (based on PECARN or NEXUS). Variant 2: Radiographs of the cervical spine are usually appropriate for the initial imaging of children 3 to 16 years of age with acute cervical spine trauma with at least one risk factor with reliable clinical examination (based on PECARN or NEXUS). The panel did not agree on recommending CT cervical spine without IV contrast or MRI cervical spine without IV contrast in children 3 to 16 years of age with this clinical condition. There is insufficient medical literature to conclude whether or not these patients would benefit from these procedures. CT cervical spine without IV contrast or MRI cervical spine without IV contrast as the initial imaging of children 3 to 16 years of age with acute cervical spine trauma and at least one risk factor with reliable clinical examination (based on PECARN or NEXUS) is controversial but may be appropriate. Variant 3: Radiographs of the cervical spine are usually appropriate for the initial imaging of children younger than 3 years of age with acute cervical spine trauma with a Pieretti-Vanmarcke weighted score greater than or equal to 2 to 8 points. The panel did not agree on recommending MRI cervical spine without IV contrast in children younger than 3 years of age with this clinical condition. There is insufficient medical literature to conclude whether or not these patients would benefit from these procedures. MRI cervical spine without IV contrast as the initial imaging of children younger than 3 years of age with acute cervical spine trauma with a Pieretti-Vanmarcke weighted score greater than or equal to 2 to 8 points is controversial but may be appropriate.
Suspected Spine Trauma Child PCAs. Exceptional indications may exist for patients with contraindications to MRI and in whom impending cord compression is suspected [90]. Summary of Recommendations Variant 1: Imaging is not recommended for the initial imaging of children 3 to 16 years of age with acute cervical spine trauma that meets low risk criteria (based on PECARN or NEXUS). Variant 2: Radiographs of the cervical spine are usually appropriate for the initial imaging of children 3 to 16 years of age with acute cervical spine trauma with at least one risk factor with reliable clinical examination (based on PECARN or NEXUS). The panel did not agree on recommending CT cervical spine without IV contrast or MRI cervical spine without IV contrast in children 3 to 16 years of age with this clinical condition. There is insufficient medical literature to conclude whether or not these patients would benefit from these procedures. CT cervical spine without IV contrast or MRI cervical spine without IV contrast as the initial imaging of children 3 to 16 years of age with acute cervical spine trauma and at least one risk factor with reliable clinical examination (based on PECARN or NEXUS) is controversial but may be appropriate. Variant 3: Radiographs of the cervical spine are usually appropriate for the initial imaging of children younger than 3 years of age with acute cervical spine trauma with a Pieretti-Vanmarcke weighted score greater than or equal to 2 to 8 points. The panel did not agree on recommending MRI cervical spine without IV contrast in children younger than 3 years of age with this clinical condition. There is insufficient medical literature to conclude whether or not these patients would benefit from these procedures. MRI cervical spine without IV contrast as the initial imaging of children younger than 3 years of age with acute cervical spine trauma with a Pieretti-Vanmarcke weighted score greater than or equal to 2 to 8 points is controversial but may be appropriate.