TOP 23 - Head CT and Cervical Spine Injury in Pediatric Patients

Publication Number: 4726.TOP 23

Karen Huang, Jacobi Medical Center, Bayside, NY, United States; James Meltzer, Albert Einstein College of Medicine, Bronx, NY, United States; Tanner W. Mercer, Albert Einstein College of Medicine, The Bronx, NY, United States; Fabliha Hussain, Albert Einstein College of Medicine, Bronx, NY, United States

Background: It is traditionally taught that significant head trauma should raise the suspicion for a potential cervical spine injury (CSI). As a result, many injured patients who receive a head computer tomography (CT) will also receive a cervical spine CT regardless of other risk factors. CSI is uncommon and the data supporting this practice is limited, particularly in children. Moreover, CT scans expose patients to substantial amounts of radiation, and children are more susceptible to its complications.

Objective: The objective of this study is to determine the risk of CSI in children evaluated for head injury who have no indication for cervical spine imaging except that they are receiving a head CT.

Design/Methods: We are conducting a retrospective cross sectional study using data from the electronic medical record of blunt trauma patients < 18 years old who received both a head CT and a cervical spine CT after presenting to one of NYC Health and Hospitals emergency departments (ED) between July 2016 to December 2023. NYC Health and Hospitals is a public hospital system consisting of 11 hospitals spread across 4 boroughs. Patients with risk factors for CSI will be excluded. We define these factors as the presence of predisposing medical conditions, GCS ≤ 14, paraesthesia, neurological deficits, altered mental status, intoxication, neck pain, bruising, midline cervical spine tenderness, or swelling. The primary outcome is any CSI, defined as any fracture, dislocation, or ligamentous injury. Secondary outcomes include radiation doses from head CT and cervical spine CT. We will perform a subgroup analysis on patients with a positive head CT.