Background/Aims: Increasing attention has been given to the possible association of cervical spine (c-spine) injuries with abusive head trauma (AHT). The aims of this study were to describe c-spine MRI findings in hospitalized AHT patients. Methods: This is a retrospective study of children under the age of 5 years with AHT admitted to hospital in 2004-2013. Those with c-spine MRI were identified, and the images were reviewed. Results: 250 AHT cases were identified, with 34 (14%) undergoing c-spine MRI. Eleven patients (32%) had 25 findings, including hematoma in 2, occiput-C1-C2 edema in 3, prevertebral edema in 6, facet edema in 2, and interspinous and/or muscular edema in 10. No patients had a clinically evident c-spine injury, a clinically unstable c-spine, or required c-spine surgery. Conclusions: C-spine MRI may identify abnormalities not apparent upon physical examination and the procedure should therefore be considered in cases of suspected AHT.

1.
Parks S, Sugerman D, Xu L, Coronado V: Characteristics of non-fatal abusive head trauma among children in the USA, 2003-2008: application of the CDC operational case definition to national hospital inpatient data. Inj Prev 2012;18:392-398.
2.
Parks SE, Kegler SR, Annest JL, Mercy JA: Characteristics of fatal abusive head trauma among children in the USA: 2003-2007: an application of the CDC operational case definition to national vital statistics data. Inj Prev 2012;18:193-199.
3.
Jacob R, Cox M, Koral K, Greenwell C, Xi Y, Vinson L, Reeder K, Weprin B, Huang R, Booth TN: MR imaging of the cervical spine in nonaccidental trauma: a tertiary institution experience. AJNR Am J Neuroradiol 2016, E-pub ahead of print.
4.
Choudhary AK, Ishak R, Zacharia TT, Dias MS: Imaging of spinal injury in abusive head trauma: a retrospective study. Pediatr Radiol 2014;44:1130-1140.
5.
Christian CW: The evaluation of suspected child physical abuse. Pediatrics 2015;135:e1337-e1354.
6.
Henry MK, Zonfrillo MR, French B, Song L, Feudtner C, Wood JN: Hospital variation in cervical spine imaging of young children with traumatic brain injury. Acad Pediatr 2016;16:684-691.
7.
Berger RP, Fromkin JB, Stutz H, Makoroff K, Scribano PV, Feldman K, Tu LC, Fabio A: Abusive head trauma during a time of increased unemployment: a multicenter analysis. Pediatrics 2011;128:637-643.
8.
Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC: Analysis of missed cases of abusive head trauma. JAMA 1999;281:621-626.
9.
Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF, Sinal SH: A population-based study of inflicted traumatic brain injury in young children. JAMA 2003;290:621-626.
10.
Scribano PV, Makoroff KL, Feldman KW, Berger RP: Association of perpetrator relationship to abusive head trauma clinical outcomes. Child Abuse Negl 2013;37:771-777.
11.
Sheets LK, Leach ME, Koszewski IJ, Lessmeier AM, Nugent M, Simpson P: Sentinel injuries in infants evaluated for child physical abuse. Pediatrics 2013;131:701-707.
12.
Shein SL, Bell MJ, Kochanek PM, Tyler-Kabara EC, Wisniewski SR, Feldman K, Makoroff K, Scribano PV, Berger RP: Risk factors for mortality in children with abusive head trauma. J Pediatr 2012;161:716-722. e711.
13.
Anderson RC, Kan P, Vanaman M, Rubsam J, Hansen KW, Scaife ER, Brockmeyer DL: Utility of a cervical spine clearance protocol after trauma in children between 0 and 3 years of age. J Neurosurg Pediatr 2010;5:292-296.
14.
Feldman KW, Weinberger E, Milstein JM, Fligner CL: Cervical spine MRI in abused infants. Child Abuse Negl 1997;21:199-205.
15.
Brennan LK, Rubin D, Christian CW, Duhaime AC, Mirchandani HG, Rorke-Adams LB: Neck injuries in young pediatric homicide victims. J Neurosurg Pediatr 2009;3:232-239.
16.
Hadley MN, Sonntag VK, Rekate HL, Murphy A: The infant whiplash-shake injury syndrome: a clinical and pathological study. Neurosurgery 1989;24:536-540.
17.
Matshes EW, Evans RM, Pinckard K, Joseph JT, Lew E: Shaken infants die of neck trauma, not of brain trauma. Acad For Path 2011;1:82-91.
18.
Kemp AM, Joshi AH, Mann M, Tempest V, Liu A, Holden S, Maguire S: What are the clinical and radiological characteristics of spinal injuries from physical abuse: a systematic review. Arch Dis Child 2010;95:355-360.
19.
Katz JS, Oluigbo CO, Wilkinson CC, McNatt S, Handler MH: Prevalence of cervical spine injury in infants with head trauma. J Neurosurg Pediatr 2010;5:470-473.
20.
Kadom N, Khademian Z, Vezina G, Shalaby-Rana E, Rice A, Hinds T: Usefulness of MRI detection of cervical spine and brain injuries in the evaluation of abusive head trauma. Pediatr Radiol 2014;44:839-848.
21.
Flaherty EG, Perez-Rossello JM, Levine MA, Hennrikus WL: Evaluating children with fractures for child physical abuse. Pediatrics 2014;133:e477-e489.
22.
Duffy SO, Squires J, Fromkin JB, Berger RP: Use of skeletal surveys to evaluate for physical abuse: analysis of 703 consecutive skeletal surveys. Pediatrics 2011;127:e47-e52.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.