Articles: spinal-injuries-diagnostic-imaging.
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Academic pediatrics · Sep 2016
Hospital Variation in Cervical Spine Imaging of Young Children With Traumatic Brain Injury.
Cervical imaging practices are poorly understood in young children with traumatic brain injury (TBI). We therefore sought to identify child-level and hospital-level factors associated with performance of cervical imaging of children with TBI from falls and abusive head trauma (AHT) and to describe across-hospital variation in cervical imaging performance. We hypothesized that imaging decisions would be influenced by hospital volume of young injured children. ⋯ These results highlight variation across hospitals in adjusted probability of cervical imaging in AHT (nearly 20-fold) and TBI from falls (over 10-fold) not explained by observed patient characteristics. This variation suggests opportunities for further research to inform imaging practices.
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J Trauma Acute Care Surg · Aug 2016
Performance improvement and patient safety program-guided quality improvement initiatives can significantly reduce computed tomography imaging in pediatric trauma patients.
Morbidity and mortality of cervical spine (C-spine) injury in pediatric trauma patients are high, necessitating quick and accurate diagnosis. Best practices emphasize minimizing radiation exposure through decreased reliance on computed tomography (CT), instead using clinical assessment, physical examination, and alternate imaging techniques. We implemented an institutional performance improvement and patient safety (PIPS) program initiative for C-spine clearance in 2010 because of high rates of CT scans among pediatric trauma patients. ⋯ Therapeutic study, level IV; diagnostic study, level III.
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AJR Am J Roentgenol · Jun 2016
Parsing the Utility of CT and MRI in the Subaxial Cervical Spine Injury Classification (SLIC) System: Is CT SLIC Enough?
The aim of our blinded retrospective study was to evaluate the diagnostic performance of the Subaxial Cervical Spine Injury Classification (SLIC) System in predicting the need for surgical intervention after subaxial cervical spine injury; SLIC scores were determined using CT alone or both CT and MRI. ⋯ SLIC scoring based on CT alone performs similarly to SLIC scoring based on CT and MRI but with improved interobserver agreement. Although MRI is useful for surgical planning, these results indicate that MRI may have limited added value in the initial triage of patients with subaxial cervical spine injury for conservative versus surgical management.
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Case Reports
Traumatic Lumbar Subdural Hematoma in the Absence of Intracranial Pathology: A Case Report.
Traumatic spinal subdural hematoma is an exceedingly rare condition, with those occurring in the absence of intracranial disease being particularly uncommon. Only 13 such cases have been reported. Although theories exist to describe the pathophysiology of traumatic spinal subdural hematoma, the precise mechanism and guidelines for management remain unclear. ⋯ Definitive guidelines for management of this condition are uncertain; however, successful use of conservative management, lumbar drainage, and surgical evacuation has been reported. This patient underwent a lumbar laminectomy with evacuation of the hematoma, resulting in immediate pain relief and resolution of symptoms within 1 week of the procedure.
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Emergency radiology · Jun 2016
Effect of spineboard and headblocks on the image quality of head CT scans.
Trauma patients at risk for, or suspected of, spinal injury are frequently transported to hospital using full spinal immobilisation. At the emergency department, immobilisation is often maintained until radiological work-up is completed. In this study, we examined how these devices for spinal stabilization influence visual image quality. ⋯ In the phantom CT scans, artifacts were present in all set-ups with one or more devices present and were seen in 20 % of all scan slices. The presence of headblocks resulted in more artifacts in both the patient CT scans and the phantom CT scans. Considerable effort should therefore be made to adjust the design of the immobilization devices and to remove the headblocks before CT scans are made.