Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 1;42(6):e607-e611.
doi: 10.1097/BPO.0000000000002146. Epub 2022 Mar 17.

A Retrospective Look at a Cervical Spine Clearance Protocol in Pediatric Trauma Patients at a Level-1 Trauma Center

Ryan S Bailey  1 , Robert Klein, Daniel de Los Cobos, Simone Geraud, Aki Puryear
Affiliations

A Retrospective Look at a Cervical Spine Clearance Protocol in Pediatric Trauma Patients at a Level-1 Trauma Center

Ryan S Bailey et al. J Pediatr Orthop. .

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Pannu GS, Shah MP, Herman MJ. Cervical spine clearance in pediatric trauma centers: the need for standardization and an evidence-based protocol. J Pediatr Orthop. 2017;37:e145–e149.
    1. Barba CA, Taggert J, Morgan AS, et al. A new cervical spine clearance protocol using computed tomography. J Trauma. 2001;51:652–656.
    1. Bandiera G, Stiell IG, Wells GA, et al. The Canadian C-Spine rule performs better than unstructured physician judgment. Ann Emerg Med. 2003;42:395–402.
    1. Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med. 2000;343:94–99.
    1. Paxton M, Heal CF, Drobetz H. Adherence to Canadian C-Spine Rule in a regional hospital: a retrospective study of 406 cases. JMed Imaging Radiat Oncol. 2012;56:514–518.

LinkOut - more resources