A New Paradigm for the Management of Thoracolumbar Pediatric Spine Traumas.
Pediatr Emerg Care
; 33(8): e10-e14, 2017 Aug.
Article
en En
| MEDLINE
| ID: mdl-26359826
ABSTRACT
OBJECTIVES:
The transient breath holding sign (TBHS) is a clinical sign often associated with magnetic resonance imaging (MRI) spine traumatic lesions. The aims of this study were to prospectively evaluate the TBHS in the detection of thoracolumbar lesions in a large cohort of children and to establish a comprehensive strategy on the use of MRI in spine traumas in children. STUDYDESIGN:
All conscious 5- to 16-year-old patients admitted for a spine trauma in our institution were prospectively included in the study. All patients were asked for the TBHS and underwent a full spine MRI. Sensitivity and specificity of the TBHS were derived from the confusion matrix. All MRI lesions were analyzed and classified.RESULTS:
One hundred ninety-eight patients were included. The sensitivity of the TBHS was 92%, the specificity was 83%, the positive predictive value was 83%, and the negative predictive value was 91%. The x-rays missed 67% of the vertebrae injured in the MRI. The MRI lesions consisted in an upper end plate injury, in the sagittal plane only, in 90% of the cases. The vertebral canal and the spinal cord were never injured.CONCLUSIONS:
This study confirms that the TBHS is a relevant clinical tool that should be added in the routine questionnaire after any trauma at admission. Magnetic resonance imaging should be restricted to patients with a TBHS positive at admission. A single T2 Short T1 Inversion Recovery (STIR) sagittal sequence seems sufficient to make the diagnosis and could replace the use of standard x-rays in pediatric spine traumas.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Traumatismos Vertebrales
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Vértebras Cervicales
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Fracturas de la Columna Vertebral
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Contencion de la Respiración
Tipo de estudio:
Diagnostic_studies
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Evaluation_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adolescent
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Child
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Child, preschool
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Female
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Humans
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Male
Idioma:
En
Revista:
Pediatr Emerg Care
Asunto de la revista:
MEDICINA DE EMERGENCIA
/
PEDIATRIA
Año:
2017
Tipo del documento:
Article
País de afiliación:
Francia