Joshua S Easter

Massachusetts General Hospital, Boston, MA, United States

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Publications (4)5.32 Total impact

  • Joshua S Easter, Roger Barkin, Carlo L Rosen, Kevin Ban
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    ABSTRACT: The diagnosis and management of cervical spine injury is more complex in children than in adults. Part I of this series stressed the importance of tailoring the evaluation of cervical spine injuries based on age, mechanism of injury, and physical examination findings. Part II will discuss the role of magnetic resonance imaging (MRI) as well as the management of pediatric cervical spine injuries in the emergency department. Children have several common variations in their anatomy, such as pseudosubluxation of C2-C3, widening of the atlantodens interval, and ossification centers, that can appear concerning on imaging but are normal. Physicians should be alert for signs or symptoms of atlantorotary subluxation and spinal cord injury without radiologic abnormality when treating children with spinal cord injury, as these conditions have significant morbidity. MRI can identify injuries to the spinal cord that are not apparent with other modalities, and should be used when a child presents with a neurologic deficit but normal X-ray study or CT scan. With knowledge of these variations in pediatric anatomy, emergency physicians can appropriately identify injuries to the cervical spine and determine when further imaging is needed.
    Journal of Emergency Medicine 09/2011; 41(3):252-6. · 1.33 Impact Factor
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    Joshua S Easter, Roger Barkin, Carlo L Rosen, Kevin Ban
    [Show abstract] [Hide abstract]
    ABSTRACT: Cervical spine injuries are difficult to diagnose in children. They tend to occur in different locations than in adults, and they are more difficult to identify based on history or physical examination. As a result, children are often subjected to radiographic examinations to rule out cervical spine injury. This two-part series will review the classic cervical spine injuries encountered in children based on age and presentation. Part I will discuss the mechanisms of injury, clinical presentations, and the use of different imaging modalities, including X-ray studies and computed tomography (CT). Part II discusses management of these injuries and special considerations, including the role of magnetic resonance imaging, as well as injuries unique to children. Although X-ray studies have relatively low risks associated with their use, they do not identify all injuries. In contrast, CT has higher sensitivity but has greater radiation, and its use is more appropriate in children over 8 years of age. With knowledge of cervical spine anatomy and the characteristic injuries seen at different stages of development, emergency physicians can make informed decisions about the appropriate modalities for diagnosis of pediatric cervical spine injuries.
    Journal of Emergency Medicine 08/2011; 41(2):142-50. · 1.33 Impact Factor
  • Journal of Emergency Medicine 08/2009; 37(1):69-74. · 1.33 Impact Factor
  • Journal of Emergency Medicine 08/2008; 35(1):77-80. · 1.33 Impact Factor

Publication Stats

9 Citations
5.32 Total Impact Points

Institutions

  • 2011
    • Massachusetts General Hospital
      • Department of Emergency Medicine
      Boston, MA, United States
  • 2009–2011
    • Boston Children's Hospital
      • Division of Emergency Medicine
      Boston, Massachusetts, United States
  • 2008
    • Beth Israel Deaconess Medical Center
      • Department of Emergency Medicine
      Boston, MA, United States