Fellow, Emergency Services Nemours Children's Health Philadelphia, Pennsylvania, United States
Background: Head imaging plays an important role in children less than 24 months old who are being evaluated for physical abuse. In 2016, the American College of Radiology began recommending cervical spine MRIs while obtaining brain MRIs, and consideration of complete spine MRIs, in patients where there is high suspicion for abusive injury in order to evaluate for unsuspected ligamentous injury or spinal subdural hemorrhage. While abusive head trauma is the primary known risk factor for abusive spinal injury, little is known about other risk factors. Objective: To determine risk factors for abusive spinal injury in patients who undergo evaluation for non-accidental trauma. Design/Methods: We performed a retrospective cross-sectional study of admitted children ≤ 2 years of age who underwent neuroimaging and full spine MRI for clinical concerns of abusive head trauma or as an occult injury screen during the work up of general physical abuse. The study was approved by the Nemours Institutional Review Board. ICD codes were used to identify admitted patients who had a full spine MRI obtained between October 2019 and July 2023 across two hospital sites. The electronic health record (EHR) was then queried to determine if patients met study inclusion criteria: any patient within the data set who was seen in the pediatric emergency department with an ultimate disposition of admission for concern of physical abuse, and subsequently had head and spinal imaging obtained. Patients were excluded if they had the spinal MRI obtained for any other reason besides screening or evaluation of abusive injury. Demographic, clinical history, physical examination, and diagnostic testing data are currently being manually extracted. Univariate and multivariate analysis will be used to compare risk factors such as age, type of head trauma, and presence of other injuries, in patients with and without positive spinal MRI findings. The analysis is expected to be complete by the end of 2023.
