I have never been the primary doc on an 'awake, alert' c-spine fracture in the pre-adolescent.
The data confirms that this is a relatively rare occurrence. I just reviewed two papers on this
topic and the most recent paper (baker et al, Pediatrics 1999) demonstrated the sensitivity of a
lateral c-spine was 79%. Other work confirms this as well.Even assuming wide confidence intervals
it means you will miss a meaningful number. It is also interesting to note that most series
demonstrate that the initial films in kids with c-spine fracture is misread in about 10%. (Dr.
Orenstein, are you out there?)
Jay Fisher MD
jay pershad wrote:
> Allow me to stir up a controversy. Do we really need an AP and odontoid film
> as part of a Pediatric C-spine series to radiologically"clear" the Cspine?
> It has been a lo....ng shift, however, I am constantly faced with an
> inadequate "open mouth" view of the odontoid ( not centered well, creating a
> pseudo-offset of the lateral masses of C1 or inadequate view of the odontoid
> ..). As far as the AP view is concerned, I cannot recall an abnormality on
> AP that I did not see on the lateral view!!
> Willing to take the heat......it's summer anyway!!
> Jay Pershad, MD
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