Somppi Laura K, Frenn Kristin A, Kharbanda Anupam B
From the Department of Pediatric Emergency Medicine, and.
Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN.
Pediatr Emerg Care. 2018 Oct;34(10):691-695. doi: 10.1097/PEC.0000000000001026.
Pediatric cervical spine injuries (CSIs) are rare but potentially fatal injuries. Plain radiographs (x-rays) and computed tomography (CT) are used to diagnose CSIs. Given concerns related to radiation exposure, the utility of x-rays in diagnosing CSIs compared with other forms of imaging must be examined.
Patients younger than 19 years presenting with possible CSI to an urban tertiary care hospital who received imaging for possible CSI between January 1, 2011, and December 31, 2013, were included. The dose-length product was abstracted from the PACS system. Test performance for x-ray, CT, and MRI were calculated and effective radiation dose by age group was analyzed using the Kruskal-Wallis Test.
A total of 671 patient charts were reviewed, 574 children were included in the study cohort. Median age of enrolled children was 9.70 (interquartile range, 4.78-13.83) years; 42.5% were female. Test performance of x-ray, CT, and MRI to detect CSI were calculated. Cervical x-rays performed only slightly inferior to CT. Sensitivity was 83% (95% confidence interval [CI], 36-99%), and specificity was 97% (95% CI, 96%-99%) versus 100% (95% CI, 96%-100%) for CT. Median effective dose of radiation for cervical CTs was 4.51 mSv (interquartile range, 3.84-5.59 mSv). Median dose significantly increased with age (2.94-5.10 mSv, P < 0.001).
Plain radiographs were largely sufficient to screen for CSIs, indicating their utility as a screening tool for CSIs. The incidence of CSIs in our sample was similar to prior reports. The effective radiation dose delivered during pediatric head and cervical CTs were lower than previously published estimates.
儿童颈椎损伤（CSI）虽罕见但可能致命。普通X线片（X光）和计算机断层扫描（CT）用于诊断CSI。鉴于对辐射暴露的担忧，必须研究X光在诊断CSI方面与其他成像形式相比的效用。
纳入2011年1月1日至2013年12月31日期间因可能的CSI到一家城市三级护理医院就诊并接受了可能的CSI成像检查的19岁以下患者。剂量长度乘积从PACS系统中提取。计算X光、CT和MRI的检测性能，并使用Kruskal-Wallis检验分析各年龄组的有效辐射剂量。
共审查了671份患者病历，574名儿童纳入研究队列。纳入儿童的中位年龄为9.70岁（四分位间距，4.78 - 13.83岁）；42.5%为女性。计算了X光、CT和MRI检测CSI的性能。颈椎X光的表现仅略逊于CT。敏感性为83%（95%置信区间[CI]，36 - 99%），特异性为97%（95% CI，96% - 99%），而CT的敏感性为100%（95% CI，96% - 100%）。颈椎CT的中位有效辐射剂量为4.51 mSv（四分位间距，3.84 - 5.59 mSv）。中位剂量随年龄显著增加（2.94 - 5.10 mSv，P < 0.001）。
普通X线片在很大程度上足以筛查CSI，表明其作为CSI筛查工具的效用。我们样本中CSI的发生率与先前报告相似。儿科头部和颈椎CT期间给予的有效辐射剂量低于先前公布的估计值。
