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Cervical spine clearance after trauma in children
Richard C E Anderson1, Eric R Scaife, Stephen J Fenton
1Department of Neurosurgery, Children's Hospital of New York, Columbia University College of Physicians and Surgeons, New York, New York, USA. rca24@columbia.edu
Insights
Implementing a new protocol safely increased non-neurosurgical staff clearance of pediatric cervical spines after trauma by nearly 60%. This protocol effectively detects injuries, reducing missed cases and improving patient care.
Area of Science:
- Pediatric Traumatology
- Emergency Medicine
- Neurosurgery
Background:
- No standardized protocols exist for pediatric cervical spine clearance post-trauma.
- Established protocols can reduce clearance time and missed injuries.
- This study evaluated a new protocol based on NEXUS criteria.
Purpose of the Study:
- To assess if re-education and a new protocol could increase non-neurosurgical staff clearance of pediatric cervical spines.
- To determine the safety and efficacy of the new protocol in detecting injuries.
- To improve efficiency in pediatric cervical spine trauma management.
Main Methods:
- Retrospective review of pediatric trauma patients (0-18 years) from 2001-2006.
- Comparison of cervical spine clearance methods and injury detection rates between two periods (pre- and post-protocol).
- Data collected on radiographic/clinical clearance, injury types, and management.
Main Results:
- Pre-protocol (2001-2003): 95% cleared by neurosurgery; 3.5% total injuries detected.
- Post-protocol (2004-2006): 62.4% cleared by non-neurosurgical personnel; 2.8% total injuries detected.
- No late-detected injuries in either period; operative stabilization rates remained low.
Conclusions:
- The new protocol effectively detects pediatric cervical spine injuries.
- Re-education and protocol implementation significantly increased non-neurosurgical clearance by nearly 60%.
- Protocols can safely facilitate cervical spine clearance by non-neurosurgical personnel in pediatric trauma.
Object:
Currently, no diagnostic or procedural standards exist for clearing the cervical spine in children after trauma. The establishment of protocols has been shown to reduce the time required to accomplish clearance and reduce the number of missed injuries. The purpose of this study was to determine if reeducation and initiation of a new protocol based on the National Emergency X-Radiography Utilization Study criteria could safely increase the number of pediatric cervical spines cleared by nonneurosurgical personnel.
Methods:
The authors collected and reviewed data regarding cervical spine clearance in children (age range 0-18 years) who presented to the emergency department at Primary Children's Medical Center in Salt Lake City, Utah, between 2001 and 2006 after sustaining significant trauma. Radiographic and clinical methods of clearing the cervical spine, as well as the type and management of injuries, were determined for two periods: Period I (January 2001-December 2003) and Period II (January 2004-February 2006). Between 2001 and 2003, 95% of 936 cervical spines were cleared by the neurosurgical service. Twenty-one ligamentous injuries (2.2%) and 12 fracture/dislocations (1.3%) were detected, and five patients (0.5%) required operative stabilization. Since January 2004, 585 (62.4%) of 937 cervical spines have been cleared by nonneurosurgical personnel. Twelve ligamentous injuries (1.3%) and 14 fracture/dislocations (1.5%) were identified, and four patients (0.4%) required operative stabilization. No late injuries were detected in either time period.
Conclusions:
The protocol outlined in the paper has been effective in detecting cervical spine injuries in children after trauma and has increased the number of cervical spines cleared by nonneurosurgical personnel by nearly 60%. Reeducation with the establishment of protocols can safely facilitate clearance of the cervical spine after trauma by nonneurosurgical personnel.
