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Management of suspected cervical spine injuries--the paediatric perspective
1Royal Children's Hospital, Melbourne.
Insights
Managing paediatric cervical spine injuries is challenging. New guidelines from The Royal Children
Area of Science:
- Paediatric Trauma Care
- Cervical Spine Injury Management
Background:
- Paediatric cervical spine immobilisation and management present significant challenges in trauma care.
- Existing management protocols in acute care facilities for suspected paediatric cervical spine injuries are often inconsistent and suboptimal.
- Key management controversies include cervical collar application, spinal clearance, patient movement, and general care principles.
Purpose of the Study:
- To address inconsistencies and sub-optimal care in paediatric cervical spine injury management.
- To develop and implement standardized clinical guidelines for the management of paediatric cervical spine injuries.
- To provide a clinical tool to guide and standardize the approach to care for these patients.
Main Methods:
- Development of comprehensive cervical spine guidelines by The Royal Children's Hospital Trauma Service and Emergency Department.
- Multidisciplinary consultation involving Emergency Department, Intensive Care Unit, Orthopaedics, Neurosurgery, Radiology, and General Surgery.
- Guidelines address specific aspects: immobilisation, radiology, spinal clearance, injury management, Philadelphia collar fitting, and ongoing care.
Main Results:
- Established standardized guidelines for paediatric cervical spine injury management.
- The guidelines aim to improve consistency and quality of care for paediatric trauma patients with cervical spine injuries.
- A structured approach is provided for immobilisation, radiological assessment, and clinical clearance of the cervical spine.
Conclusions:
- The developed guidelines provide a standardized framework for managing paediatric cervical spine injuries.
- Implementation of these guidelines is expected to improve patient outcomes and reduce management variability.
- These guidelines serve as a crucial clinical tool for healthcare professionals managing paediatric trauma.
Abstract:
Paediatric cervical spine immobilisation and management is one of the most difficult tasks to master in the paediatric trauma population. The Royal Children's Hospital--Melbourne has admitted 54 patients with diagnosed cervical spine injuries since January 1999. The management of such patients admitted to acute care facilities with suspected cervical spine injuries is inconsistent and at times sub-optimal. Management controversies centre around, application of cervical collars, clearance of the c-spine, patient movement and general care principles. In an endeavour to address these issues, the Royal Children's Hospital Trauma Service, in conjunction with the Emergency Department developed cervical spine guidelines. Teams consulted in the formulation of these guidelines included, Emergency Department, Intensive Care Unit, Orthopaedics, Neurosurgery, Radiology and General Surgery. These guidelines were developed as a clinical tool to guide management and standardise the approach of care for these patients. Specifically, the guidelines address: immobilisation of the paediatric cervical spine; radiology; clearing the cervical spine of injury; suspected or proven cervical spine injury; guidelines for times to fitting Philadelphia collar; ongoing care.