The value of routine cervical spine, chest, and pelvis radiographs in children after trauma

The appropriate use of imaging to screen infants and children for injuries after trauma remains controversial, and routine radiographs of the cervical spine, chest, and pelvis are still obtained at some centers. The purpose of this study was to document the abnormalities encountered on such films obtained in 292 pediatric trauma patients to evaluate the worth of obtaining such studies, particularly in children who are asymptomatic and have no clinical findings referable to these areas. The medical records, radiographs, and other imaging studies of 292 children evaluated in the emergency department after trauma were retrospectively reviewed. Ages ranged from 5 months to 17 years (mean ± 10 years). The numbers and types of abnormal imaging findings were documented for each patient and were correlated with the type of injury, patient complaints, physical examination findings, level of consciousness, and laboratory abnormalities. Final diagnosis and short-term outcome were also documented. The most common causes of injury were motor vehicle accidents (55.1%), automobile-pedestrian accidents (14.7%), and falls (13.4%). Acute cervical spine injuries were found in 2 patients (0.7%), radiographic abnormalities of the chest were found in 11 patients (3.8%), and pelvic fractures were detected in 6 patients (2.0%). All except 1 of the 19 confirmed injuries were associated with local symptoms and/or signs or were found in patients with altered mental status. A stable cervical fracture was found in one infant who was too young to complain of neck pain or tenderness. Twenty-two patients (7.5%) were asymptomatic with no physical findings, and in none of these children were any imaging abnormalities detected. We conclude that routine posttrauma radiographs of the cervical spine, chest, and pelvis are of limited utility and are not warranted in children and adolescents who are alert and demonstrate no associated symptoms or physical findings. Radiography, particularly of the cervical spine, may be worthwhile in infants and young children, but we advocate selective imaging in such patients.