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A Retrospective Look at a Cervical Spine Clearance Protocol in Pediatric Trauma Patients at a Level-1 Trauma Center
Ryan S Bailey1, Robert Klein, Daniel de Los Cobos
1Department of Orthopaedic Surgery, Saint Louis University, St. Louis, MO.
Insights
A standardized cervical spine clearance protocol effectively identified all significant injuries in pediatric trauma patients, preventing missed injuries. This approach may reduce radiation exposure and healthcare costs.
Area of Science:
- Trauma care
- Pediatric emergency medicine
- Spinal injury management
Background:
- Adult studies confirm written protocols' efficacy for cervical spine clearance.
- Pediatric trauma centers underutilize documented protocols, despite potential benefits.
- Limited data exists on pediatric cervical spine clearance protocols, yet interest is high.
Purpose of the Study:
- To evaluate the effectiveness of an implemented cervical spine clearance protocol in detecting injuries in pediatric trauma patients.
- To assess the protocol's impact on missed injuries, radiation exposure, and healthcare resource utilization.
Main Methods:
- Retrospective review of pediatric patients (May 2010-October 2018) at a level-1 pediatric trauma hospital.
- Analysis of cervical spine injury presence, clearance documentation, imaging, and follow-up for missed injuries.
- Utilized a consistent written cervical spine clearance protocol throughout the study period.
Main Results:
- No missed cervical spine injuries were identified.
- 563 clinically significant cervical spine injuries were detected (16.5% of patients).
- Advanced cervical spine imaging decreased over time (43.2% of patients).
Conclusions:
- Documented cervical spine clearance protocols are effective in detecting significant injuries in pediatric trauma patients.
- Protocols minimize the risk of missed injuries and may reduce unnecessary radiation, delayed clearance, and prolonged hospitalization.
- Further research is needed for optimal evaluation and management of pediatric cervical spine trauma.
Background:
Adult studies have demonstrated the efficacy of written protocols for clearance of the cervical spine. However, less than half of recently surveyed pediatric trauma centers report using a documented protocol. Little data exists on such protocols in pediatric populations, but interest remains because of potential reductions in radiation exposure, time to clearance, hospital stay, and specialist referral. However, missed injury can have devastating consequences. The purpose of this study is to examine the efficacy in detecting injury of an implemented cervical spine clearance protocol at a level-1 pediatric trauma hospital.
Methods:
A retrospective review was performed on pediatric patients presenting as activated traumas to the emergency department of a single level-1 pediatric trauma hospital between May 2010 and October 2018. This institution has utilized a written cervical spine clearance protocol throughout this time. Presence of cervical spine injury, documented clearance, cervical spine imaging, and follow-up documentation were reviewed for any missed injuries.
Results:
There were no missed cervical spine injuries. Five-hundred sixty-three clinically significant cervical spine injuries were identified, representing 16.5% of patients. Of these, 96 were fractures, dislocations, or ligamentous injuries, representing 2.8% of all patients. Most cervical spine clearances were performed by trauma surgery. Advanced imaging of the cervical spine was ordered for 43.2% of patients overall and trended down over time.
Conclusion:
Documented cervical spine clearance protocols are effective for detection of significant injury in pediatric trauma patients. This study suggests these protocols minimize risk of missed injury and may prevent unnecessary radiation exposure, delayed clearance, prolonged hospitalization, or unnecessary specialist referral.
Clinical Relevance:
Utilization of a standard written protocol for cervical spine clearance likely prevents missed injury and helps to minimize radiation exposure in pediatric populations. Further research is needed on evaluation and management of pediatric cervical spine trauma.
