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Traumatic pediatric cervical spine injury—a proposed clearance algorithm incorporating a 24-h time delay
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Traumatic pediatric cervical spine injury—a proposed clearance algorithm incorporating a 24-h time delay
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Journal Article
Traumatic pediatric cervical spine injury—a proposed clearance algorithm incorporating a 24-h time delay
2024
Overview
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.
Publisher
Springer Berlin Heidelberg,Springer Nature B.V
