Cervical spine trauma in children under 5 years: productivity of CT

The aim of the study was to determine the value of CT in the evaluation of cervical spine trauma in children under 5 years in the Emergency Department. A retrospective review of 606 patients undergoing cervical spine examination in the emergency room was undertaken. The age and sex of the patients were documented, and in addition presence or absence of fracture-dislocation was noted on each of the plain film and CT studies. Of the 606 patients studied, 459 (75.7%) were cleared by a combination of clinical and plain film radiographic findings. The other 147 (24.3%) went on to CT imaging for clearing of the cervical spine. Of the 147 patients evaluated with CT, 143 (97.3%) had exams that were negative for fracture, dislocation, and instability. Only four (2.7%) demonstrated positive findings for fracture, dislocation, or instability. All of these patients had positive, diagnostic findings on initial plain film evaluation. Another five patients demonstrated new findings which were unrelated to trauma and of no clinical consequence. The yield of positive, clinically significant findings on CT of cervical spine injuries in children less than 5 years was low and showed significant findings only in patients where the same findings were seen on initial plain radiographs.