Cervical spine MRI in abused infants.

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.