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X Ray Versus Ct For Traumatic Paediatric Cervical Spine Imaging : What Guidance Do Clinicans Have?

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X-RAY VERSUS CT FOR TRAUMATIC PAEDIATRIC CERVICAL SPINE IMAGING: WHAT GUIDANCE DO CLINICANS HAVE?
Introduction:
Evidence shows that road traffic accidents are the most common cause of paediatric cervical spine (c-spine) injury, with many dying at the scene (Booth, 2012). On presentation to the hospital, assessment of the paediatric patient requires recognition of subtle signs and symptoms, often in the setting of distracting injuries (Jones, Anderson and Noonan, 2011). Since history taking from a paediatric trauma patient is especially difficult, clinicians may be forced to use imaging for full evaluation (Tepper, Brice and Hobgood, 2013). This is a difficult decision to make, and formal guidance is lacking (Booth, 2012).
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Since high speed road traffic accidents are the most common cause of spinal injury in the under 8s (Egloff et al., 2009), clinicians should not be prudish in their approach to imaging.
On examination, she was moving all four limbs spontaneously, and there was no evidence of neurological deficit. However, she avoided head movement, choosing to look sideways with her eyes, and cried on palpation of her spinous processes. Marked soft tissue swelling on the neck and torso from the seat restraints was noted, along with a bruise on her cheek. Slack and Clancy (2004) state that patients with an injury above the clavicles and all patients involved in high speed vehicular accidents should be assumed to have a spinal injury.
Initially, a single view radiograph was requested to evaluate the potential injury findings. A horizontal-beam lateral was performed as it is the most sensitive view at 75% in the under 8s, and 93% in over 8s and may even suffice as a standalone projection (Ropele, Bleck and Vander Laan, 2009), which emphasises the importance of optimal imaging technique. The open-mouth odontoid images are difficult to acquire in young children due to poor compliance and should not be routinely performed (Agius et al., 2012).
The resultant image demonstrated a possible atlanto-axial instability with anterior dislocation of C1 (fig. 1(a)). According to (Booth, 2012), the anterior and posterior cervical and spinolaminar lines should be assessed (fig. 1(c)) recognizing that

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