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Cervical spine clearance in the nonalert, noncommunicative, or unreliable pediatric blunt trauma patient
Diana Ropele1, Kari Blech, Karen J Vander Laan
1Pediatric Trauma Program Nurse, Helen DeVos Children's Hospital, Spectrum Health in Grand Rapids, Michigan, USA. diana.ropele@devoschildrens.org
Insights
Pediatric cervical spine clearance lacks a national guideline for trauma patients. Current practices vary widely among US trauma centers regarding diagnostic testing sequences and time frames for children.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Neurosurgery
Background:
- Absence of a nationally recognized, evidence-based guideline for cervical spine clearance in pediatric blunt trauma patients who are nonalert, noncommunicative, or unreliable.
- Need to understand current practices and expert opinions in specialized pediatric trauma centers within the United States.
Purpose of the Study:
- To identify current practices for pediatric cervical spine clearance in US trauma centers.
- To elicit expert opinion data on diagnostic testing sequences and time frames for pediatric cervical spine clearance.
- To explore perceived barriers and supports for implementing standardized diagnostic testing protocols.
Main Methods:
- Descriptive survey study utilizing a 93-item electronic Pediatric Cervical Spine Clearance Survey.
- Survey distributed to 309 members of the Pediatric Special Interest Group of the National Society of Trauma Nurses.
- Analysis of responses from 44 participating trauma centers regarding trauma verification, case volume, and diagnostic testing protocols.
Main Results:
- Significant variability exists in the diagnostic testing sequences and time frames employed by trauma centers for pediatric cervical spine clearance.
- Respondents provided data on trauma case volumes and specific diagnostic approaches utilized for different pediatric age groups.
- Identified perceived supports and barriers influencing the adherence to target time frames for diagnostic testing.
Conclusions:
- Current approaches to pediatric cervical spine clearance in trauma centers are heterogeneous, lacking standardization.
- The findings highlight the need for developing a national, evidence-based guideline to ensure consistent and optimal care for pediatric trauma patients.
- Further research is warranted to evaluate the impact of a standardized cervical spine clearance guideline on patient outcomes.
Abstract:
Currently, there is no nationally recognized evidence-based guideline or protocol for cervical spine clearance in nonalert, noncommunicative, or unreliable pediatric blunt trauma patients. This descriptive survey study sought to identify current practices and elicit expert opinion data regarding pediatric cervical spine clearance in a specialized population of children in trauma centers in the United States. A 93-item electronic Pediatric Cervical Spine Clearance Survey was sent to 309 members of the Pediatric Special Interest Group of the National Society of Trauma Nurses. The main areas of interest in the survey included trauma verification, annual volume of pediatric trauma cases, and sequence and time frames of diagnostic testing for cervical spine clearance by age group. Additional areas of interest were perceived supports and barriers to meeting target time frames for diagnostic testing and outcomes to evaluate the impact of a cervical spine clearance guideline for pediatric blunt trauma. The results from 44 respondents demonstrate that trauma centers are using a variety of diagnostic testing sequences and time frames when clearing children for suspected cervical spine injury.
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Assessment:
1. Clinical Evaluation:
History: