Imaging Evaluation for Thoracic Spine Fractures in Pediatric Trauma Patients

Abstract

Background Imaging workup for evaluating thoracic spine fracture (TSF) in pediatric blunt trauma is variable. Purpose The aim of the study was to determine the number of TSFs missed by radiography and identified on computed tomography (CT) or magnetic resonance imaging (MRI) that required intervention or resulted in a change in management. Methods A retrospective review of children with TSFs was performed. Diagnostic images and reports for these patients were reviewed. Data regarding demographics, clinical presentation, management, and outcomes were extracted from institutional electronic medical records. Use of radiographs, CT, and MRI for evaluation of TSF was quantified. Incidence of TSFs was calculated and stratified by mechanism. The number of TSFs and complicating factors missed on radiography but identified on subsequent CT or MRI were quantified. Results Three thousand two hundred sixty-five trauma patients 18 years or younger were reviewed. Of these, 3.3% (90/3265) had TSFs (36 females, 54 males; mean age, 10.80 ± 4.4 years). The most common mechanism of injury was fall (43% [39/90]) followed by motor vehicle collisions (30% [27/90]). The most common fracture was simple compression fracture 64%, which occurred most frequently in the mid thoracic spine, followed by transverse process fractures 19% and spinous process fractures 7%. Almost half of all TSFs diagnosed on CT and/or MRI were missed on initial radiographs. While all fractures that required operative management were identified on radiographs, 13 of the 19 fractures that required nonoperative intervention were missed. Conclusions Approximately 50% of TSFs diagnosed on CT or MRI were not identified on preceding radiographs. This is similar to studies in adult populations that show poor sensitivity of radiographs.