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Cervical Spine Imaging and Injuries in Young Children With Non-Motor Vehicle Crash-Associated Traumatic Brain Injury

Henry, M. Katherine, MD, MSCE*†; French, Benjamin, PhD; Feudtner, Chris, MD, PhD, MPH*†§; Zonfrillo, Mark R., MD, MSCE; Lindberg, Daniel M., MD; Anderst, James D., MD, MSCI#; Berger, Rachel P., MD, MPH**; Wood, Joanne N., MD, MSHP*†§††

doi: 10.1097/PEC.0000000000001455
Original Article: PDF Only

Objectives The aim of this study was to evaluate cervical magnetic resonance imaging (MRI) and computed tomography (CT) practices and cervical spine injuries among young children with non–motor vehicle crash (MVC)–associated traumatic brain injury (TBI).

Methods We performed a retrospective study of a stratified, systematic random sample of 328 children younger than 2 years with non-MVC-associated TBI at 4 urban children's hospitals from 2008 to 2012. We defined TBI etiology as accidental, indeterminate, or abuse. We reported the proportion, by etiology, who underwent cervical MRI or CT, and had cervical abnormalities identified.

Results Of children with non-MVC-associated TBI, 39.4% had abusive head trauma (AHT), 52.2% had accidental TBI, and in 8.4% the etiology was indeterminate. Advanced cervical imaging (CT and/or MRI) was obtained in 19.1% of all children with TBI, with 9.3% undergoing MRI and 11.7% undergoing CT. Cervical MRI or CT was performed in 30.9% of children with AHT, in 11.7% of accidental TBI, and in 10.7% of indeterminate-cause TBI. Among children imaged by MRI or CT, abnormal cervical findings were found in 22.1%, including 31.3% of children with AHT, 7.1% of children with accidental TBI, and 0% of children with indeterminate-cause TBI. Children with more severe head injuries who underwent cervical imaging were more likely to have cervical injuries.

Conclusions Abusive head trauma victims appear to be at increased risk of cervical injuries. Prospective studies are needed to define the risk of cervical injury in children with TBI concerning for AHT and to inform development of imaging guidelines.

From the *Division of General Pediatrics, †Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; ‡Department of Biostatistics and Epidemiology, University of Pennsylvania; §Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; ∥Department of Emergency Medicine and Injury Prevention Center, Alpert Medical School of Brown University and Hasbro Children's Hospital, Providence, RI; ¶Department of Emergency Medicine and The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, Aurora, CO; #Division of Child Abuse and Neglect, Department of Pediatrics, University of Missouri Kansas City School of Medicine and Children's Mercy Hospital, Kansas City, MO; **Department of Pediatrics, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh; and ††PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA.

Conflicts of Interest and Source of Funding: This study was supported through salary support by the National Institutes of Health/Eunice Kennedy Shriver National Institute of Child Health and Human Development institutional training grant 5T32H060550-05 (Dr Henry), National Institutes of Health/Eunice Kennedy Shriver National Institute of Child Health and Human Development Career Development Awards 1K23HD071967 (Dr Wood) and K08HD073241 (Dr Zonfrillo), and Agency for Healthcare Research and Quality F32HS024194 (Dr Henry). The Children's Hospital of Philadelphia has received payment for Dr Wood's and Dr Henry's expert testimony after subpoenas in cases for suspected child abuse. Dr Lindberg has provided paid expert witness testimony in cases of alleged child physical abuse. This project was supported by grant number F32HS024194 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. Study sponsors were not involved in the study design; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the paper for publication.

Reprints: M. Katherine Henry, MD, MSCE, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, 12NW93, Philadelphia, PA 19104 (e-mail:

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