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Clearing the cervical spine of paediatric trauma patients
1Department of Accident and Emergency Medicine, North Hampshire Hospital, Basingstoke, UK. suslack@doctors.org.uk <suslack@doctors.org.uk>
Insights
This review provides guidance for safely clearing the pediatric cervical spine after trauma. Alert children with normal exams may be cleared clinically, while others require imaging such as X-rays, CT, or MRI.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Care
- Radiology
Background:
- Cervical spine clearance in children post-trauma lacks definitive evidence.
- Existing guidelines are often extrapolated from adult protocols.
- Safe and effective management strategies are crucial for pediatric trauma patients.
Purpose of the Study:
- To review available evidence on pediatric cervical spine clearance.
- To develop practical guidance for safe clinical application.
- To highlight differences from adult clearance protocols.
Main Methods:
- Comprehensive literature review of scientific papers.
- Inclusion of standard textbook reviews.
- Consultation and liaison with pediatric trauma experts.
Main Results:
- 241 papers were identified; 71 were deemed relevant and appraised.
- Three patient groups identified: alert/asymptomatic, symptomatic/signs, impaired consciousness.
- Clinical clearance for alert/asymptomatic children; imaging (X-ray, CT, MRI) for others based on findings.
Conclusions:
- Limited evidence exists for pediatric cervical spine clearance.
- Proposed approach aligns with adult recommendations, with noted pediatric-specific considerations.
- Guidance aims to standardize and improve safety in pediatric trauma care.
Objectives:
To review the evidence available for clearance of the cervical spine in children under 16 years of age after trauma, and to provide guidance to enable this to be practised safely.
Methods:
A comprehensive literature review was carried out, and combined with a review of standard texts and liaison with experts.
Results:
241 papers were identified, of which 71 papers were thought possibly relevant. These were obtained and appraised. Children in whom there is concern about possible cervical spine injury may be divided into three groups. Alert, asymptomatic children with a normal examination may be clinically cleared without need for radiology. Children with cervical spine symptoms or signs require plain radiology in the first instance. Those areas that are poorly visualised or suspicious should be discussed with a paediatric radiologist and are likely to undergo computed tomography. Children with impaired conscious level require careful evaluation. Plain radiology, if normal, can be usefully complemented by early magnetic resonance imaging to exclude ligamentous and spinal cord damage.
Conclusions:
There is limited evidence to guide clinicians on how to clear the paediatric cervical spine. The approach suggested is similar to adult recommendations made elsewhere, and the differences are highlighted.
