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. 2024 Dec 16;41(1):58.
doi: 10.1007/s00381-024-06716-x.

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

Victoria E Fischer  1   2 , Vaidehi M Mahadev  3   4 , Jacob A Bethel  4   5 , Jaime A Quirarte  4   5 , Robert J Hammack  6 , Cristian Gragnaniello  3   4 , Izabela Tarasiewicz  3   4
Affiliations

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

Victoria E Fischer et al. Childs Nerv Syst. .

Abstract

Purpose: Pediatric cervical spine injury (pCSI) is rare. Physiological differences necessitate alternate management from adults. Yet, no standardized pediatric protocols exist. Previous investigations applying adult-validated clinical decision rules (CDRs)-NEXUS Criteria (NX) and Canadian C-spine Rules (CCR)-to children are mixed. We hypothesized a combined NX + CCR approach applied at a delayed 24-h time point would enhance screening efficacy in select patients.

Methods: We conducted a retrospective review of a prospectively-collected database over 15 months at a pediatric-capable Level-1 trauma center. Age and mechanism determined initial inclusion. NX and CCR criteria were collected and retroactively applied on arrival (T0) and 24 h later (T1). Statistical analyses were performed in SPSS.

Results: A total of 306 patients met inclusion. Current practices compel computed tomography (CT) overuse for craniocervical evaluations: 298 (97.4%) underwent ≥ 1 CT. Of cervical spines imaged (n = 175), 161 (92.0%) underwent CT while 74 (42.3%) underwent magnetic resonance imaging with 14 (18.9%) completed after 72 h. Of collars placed on arrival (n = 181), 136 (75.1%) were cleared before discharge with 86 (63.2%) CTs denoting preferred clearance modality; CT utilization was unchanged when stratified by age < 5 years (p = 0.819). Notably, we found more patients met NX + CCR criteria at T1 versus T0 (p = 0.008) without missed pCSI resulting in imaging overutilization in 15 (8.6%) patients.

Conclusion: We showed incorporating a 24-h time delay before a second CDR reapplication may enhance screening efficacy in pCSI. Our new algorithm combines these findings with other literature-based recommendations and may represent a standardizable option for evaluating pCSI in the acute trauma setting.

Keywords: Canadian C-Spine Rules; Children; Clinical decision rule; NEXUS Criteria.

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Conflict of interest statement

Declarations. Ethics approval: This retrospective chart review study involving human participants was conducted in accordance with ethical criterions of the national and institutional research committee and with the 1964 Helsinki Declaration as well as its subsequent amendments or analogous ethical standards. The University of Texas Health at San Antonio’s human Investigation Review Committee approved this study prior to its commencement. Competing interests: The authors declare no competing interests.

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