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Trauma association of Canada Pediatric Subcommittee National Pediatric Cervical Spine Evaluation Pathway: consensus
Seen Chung1, Angelo Mikrogianakis, Paul W Wales
1Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
The Trauma Association of Canada developed evidence-based pediatric cervical spine clearance guidelines. These guidelines provide two pathways for evaluating pediatric patients based on clinical examination reliability.
Area of Science:
- Pediatric Traumatology
- Clinical Guideline Development
- Evidence-Based Medicine
Background:
- The Institute of Medicine advocates for clinical guidelines to enhance patient outcomes.
- In 2006, the Trauma Association of Canada Pediatric Committee initiated the development of a national pediatric cervical spine (c-spine) clearance guideline.
- The guideline development was based on a comprehensive review of existing literature, algorithms, and expert opinions.
Purpose of the Study:
- To establish an evidence-based, national guideline for pediatric cervical spine clearance.
- To create standardized pathways for evaluating pediatric patients with potential cervical spine injuries.
Main Methods:
- A systematic literature review was conducted using PubMed, with search terms including "cervical spine," "c-spine," "clearance," and "trauma."
- Inclusion criteria focused on English-language articles, human subjects, specific article types (meta-analyses, guidelines, RCTs, reviews), and pediatric age groups (0-18 years).
- Multiple literature searches were performed between 2006 and 2009, followed by the development and iterative refinement of draft guidelines through various communication methods, including videoconferences, to reach consensus.
Main Results:
- A consensus was achieved on two distinct evaluation pathways for the pediatric cervical spine.
- These pathways differentiate based on the reliability of the patient's clinical examination.
Conclusions:
- The consensus guidelines from the Trauma Association of Canada provide a framework for pediatric cervical spine evaluation.
- The guidelines offer specific pathways for patients with reliable and unreliable clinical examinations, aiming to standardize care and improve outcomes.
Background:
The Institute of Medicine calls for the use of clinical guidelines and practice parameters to promote "best practices" and improve patient outcomes. In 2006, The Trauma Association of Canada Pediatric Committee set out to create an evidence-based, national pediatric cervical spine (c-spine) clearance guideline based on the literature, existing algorithms from each pediatric trauma center and from expert opinion from across Canada.
Methods:
A review of the literature took place in September 2006 using the PubMed database. Search criteria were "cervical spine," "c-spine," "clearance," and "trauma." Limits that were applied were "Languages: English," "Humans," "Type of Article: Meta-Analysis, Practice Guidelines, Randomized Control Trial, Review," and "Ages: all child 0-18 years." These search criteria were repeated in December 2007, April 2009, and October 2009. A total of 248 articles were identified. Existing guidelines were identified and their practices examined as models of care. Two draft guidelines were created for discussion: one for the pediatric patient with a reliable clinical examination and the other for the pediatric patient with an unreliable clinical examination. Via email, telephone, and two national videoconferences, the content of the guidelines was reviewed, discussed, and amended. The final article was prepared and circulated for author input until consensus was reached.
Results:
A consensus was reached on two pathways to evaluate the pediatric cervical spine: a patient with a reliable clinical examination and a patient with an unreliable examination.
Conclusion:
Presented herein are the consensus Trauma Association of Canada, National Pediatric Cervical Spine Evaluation Pathways for the patient with a reliable clinical examination, and the patient with and unreliable clinical examination.
