CERVICAL-SPINE MRI IN ABUSED INFANTS

Objective: To determine clinical utility of screening with cervical sp ine MRI to detect unsuspected cord injury in children with head injury from child abuse. Design: Prospectively collected case series. Settin g-Tertiary care children's hospital and county medical examiner's offi ce. Patients: Twelve children with intracranial injury secondary to ch ild abuse. None was clinically suspected to have cord injury. includes all eligible children whose attending felt: (a) needed follow-up cran ial imaging; (b) could be safely imaged; and(c) whose caretakers conse nted between November, 1991 and September, 1994. Interventions: MRI sc ans of the cervical spine were obtained either more than 3 days after clinical presentation or postmortem. Main Outcome Measures: Clinical o bservations by neurologist, child protection team pediatrician and med ical examiners by prospective protocol. MRI scans evaluated by prospec tive radiology protocol with emphasis on cervical cord injury. Results : Four of the five autopsied children had small subdural or subarachno id hemorrhages at the level of the cervical spine; MRI scan did not id entify them. MRI did nor identify cord injury in any child studied. Co nclusion: 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. Copyright (C) 1997 Elsevier Science Ltd.