Traumatic pediatric cervical spine injury-a proposed clearance algorithm incorporating a 24-h time delay

Area of Science:

• Pediatric Emergency Medicine
• Trauma Surgery
• Radiology

Background:

• Pediatric cervical spine injury (pCSI) is rare, with unique physiological differences from adults.
• Current management lacks standardized pediatric protocols, leading to inconsistent application of adult-validated clinical decision rules (CDRs).
• Previous studies show mixed results when applying NEXUS Criteria (NX) and Canadian C-spine Rules (CCR) to children.

Purpose of the Study:

• To evaluate the efficacy of a combined NX + CCR approach for pCSI screening.
• To test the hypothesis that a delayed 24-hour reapplication of CDRs enhances screening accuracy.
• To identify potential improvements in diagnostic yield and reduction in imaging overuse.

Main Methods:

• Retrospective review of a prospectively collected database (15 months) at a Level-1 trauma center.
• Inclusion based on age and mechanism of injury.
• Retroactive application of NX and CCR criteria at initial presentation (T0) and 24 hours later (T1).

Main Results:

• 306 patients met inclusion criteria; 97.4% underwent CT scans.
• More patients met combined NX + CCR criteria at T1 (24h) versus T0 (initial presentation) (p=0.008).
• No pCSI cases were missed with the delayed application, suggesting potential for reduced imaging overuse (15 patients, 8.6%).

Conclusions:

• Incorporating a 24-hour delay for a second CDR reapplication may enhance pCSI screening efficacy.
• A novel algorithm combining delayed CDR reapplication with literature-based recommendations could standardize pCSI evaluation.
• This approach may offer a more accurate and efficient method for managing pCSI in acute trauma.