A New Paradigm for the Management of Thoracolumbar Pediatric Spine XXXX .

@entity1 @entity75 @entity130
OBJECTIVES: The transient breath holding sign (TBHS) is a clinical sign often associated with magnetic resonance imaging (MRI) spine traumatic lesions. The aims of this study were to prospectively evaluate the TBHS in the detection of thoracolumbar lesions in a large cohort of @entity1 and to establish a comprehensive strategy on the use of MRI in spine traumas in @entity1 . STUDY DESIGN: All conscious 5- to 16-year-old @entity1 admitted for a spine @entity130 in our institution were prospectively included in the study. All @entity1 were asked for the TBHS and underwent a full spine MRI. Sensitivity and specificity of the TBHS were derived from the confusion matrix. All @entity75 were analyzed and classified. RESULTS: One hundred ninety-eight @entity1 were included. The sensitivity of the TBHS was 92%, the specificity was 83%, the positive predictive value was 83%, and the negative predictive value was 91%. The x-rays missed 67% of the vertebrae injured in the MRI. The @entity75 consisted in an @entity130 , in the sagittal plane only, in 90% of the cases. The vertebral canal and the spinal cord were never injured. CONCLUSIONS: This study confirms that the TBHS is a relevant clinical tool that should be added in the routine questionnaire after any @entity130 at admission. Magnetic resonance imaging should be restricted to @entity1 with a TBHS positive at admission. A single T2 Short T1 Inversion Recovery (STIR) sagittal sequence seems sufficient to make the diagnosis and could replace the use of standard x-rays in pediatric spine traumas.
