Cervical spine MRI in abused infants

Abstract

Objective: To determine clinical utility of screening with cervical spine MRI to detect unsuspected cord injury in children with head injury from child abuse.

Design: Prospectively collected case series. Setting-Tertiary care children's hospital and county medical examiner's office.

Patients: Twelve children with intracranial injury secondary to child abuse. None was clinically suspected to have cord injury. Includes all eligible children whose attending felt: (a) needed follow-up cranial imaging: (b) could be safely imaged; and (c) whose caretakers consented between November, 1991 and September, 1994.

Interventions: MRI scans of the cervical spine were obtained either more than 3 days after clinical presentation or postmortem.

Main outcome measures: Clinical observations by neurologist, child protection team pediatrician and medicinal examiners by prospective protocol. MRI scans evaluated by prospective radiology protocol with emphasis on cervical cord injury.

Results: Four of the five autopsied children had small subdural or subarachnoid hemorrhages at the level of the cervical spine; MRI scan did not identify them. MRI did not identify cord injury in any child studied.

Conclusion: Routine cervical spine MRI scans are probably not warranted in children with head injury secondary to child abuse without clinical symptoms of cervical cord injury.