The efficacy of magnetic resonance imaging in pediatric cervical spine clearance

Study Design. A retrospective chart analysis of pediatric trauma patients with suspected cervical spine injury was performed. Objectives. This study was designed to evaluate the efficacy and cost-efficiency of a magnetic resonance imaging (MRI) protocol for cervical spine clearance in pediatric trauma patients. Summary of Background Data. The evaluation of cervical spine injury in the pediatric trauma population can be difficult. In obtunded or uncooperative children, MRI can be valuable in defining injuries of the cervical spine not detected by plain radiographs and computed tomography. Methods. In 1993, a protocol was instituted at a pediatric trauma center using MRI to evaluate the cervical spine of children who could not be cleared within 72 hours. Using the trauma registry from February 1989 through September 1996, children with suspected cervical spine injury who were intubated at the time of hospital admission and who remained in the intensive care unit for at least 3 days were identified. The patients were divided into two cohorts: a "preprotocol group" and a "postprotocol group," consisting of patients before or after institution of the MRI protocol in September 1993. Medical records were reviewed to determine the time to cervical spine clearance, the number of days in the intensive care unit, and hospital days for each group. Biostatistical analysis was performed by an independent professional statistician. Results. Fifty-one patients in each group met the inclusion criteria. In the preprotocol group, 19 patients underwent MRI at an average of 6.8 days after admission. In the postprotocol group, 31 MRIs were performed at an average of 2.5 days from admission. Time to cervical spine clearance decreased from 5.1 days in the preprotocol group to 3.2 days in the postprotocol group (P = 0.003). The average intensive care unit stay decreased from 9.2 days in the preprotocol group to 7.3 days in the postprotocol group (P = 0.122). The average hospital stay decreased from 20.1 days in the preprotocol group to 15,5 days in the postprotocol group (P = 0.106). Factoring charges for MRI, intensive care unit beds, and hospital beds, savings of $7,700 per patient were estimated. Conclusions. In obtunded and intubated pediatric trauma patients with suspected cervical spine injury, the clearance protocol using cervical spine MRI was effective and cost-efficient.