Cervical Spine Injury in Children and Adolescents

Jea, Andrew; Belal, Ahmed; Zaazoue, Mohamed A.; Martin, Jonathan E.

doi:10.1016/j.pcl.2021.04.012

Cited by 4 publications

(1 citation statement)

References 31 publications

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“…Cervical spine injuries (CSI), mainly caused by falls and traffic accidents, are associated with damage to other organs, reduced quality of life, increased morbidity, and increased mortality rates [ 1 ]. The detection of cervical spine stability is challenging when performed during injury and reduced consciousness [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of National Emergency X-Radiography Utilization Study (NEXUS) Criteria in Pediatrics: A Systematic Review

Ekhator¹,

Nwankwo²,

Nicol³

2022

Cureus

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Since its introduction in 1992, the National Emergency X-Radiography Utilization Study (NEXUS) criteria have been used in trauma to decide whether a patient requires radiographic imaging. The tool is important in reducing radiation exposure. However, applying the NEXUS criteria for cervical spine imaging in pediatric patients is poorly supported compared to their use in adults. The objective of this review was to examine the effectiveness of using the NEXUS criteria in the diagnostic management of pediatric cervical spine injuries (CSI). The following databases were searched for studies focused on applying the NEXUS criteria for CSI in pediatric patients: Cochrane, PubMed, Google Scholar, EMBASE, ELSEVIER, and ScienceDirect. Additional studies were found through reference lists of primary sources and previous systematic and meta-analyses. The search focused on randomized controlled trials (RCTs), cohort studies, retrospective studies, prospective studies, and other uncontrolled trials published from 2000 to 2022. There were seven included studies with a total of 4502 pediatric patients. Five of the included studies were retrospective studies, while the remaining were prospective and case studies. Our results show that the sensitivity ranged from 43% to 100%, while the specificity ranged from 12.93% to 96%. The sensitivity increased with age, with those under the age of two or under the age of eight reporting poorer outcomes than the older pediatric patients. One study also shows that the proportion of patients undergoing cervical spine CT increased from 18% to 61% in the initial period before the implementation of clearance guidelines. The implementation of guidelines led to a 23% decrease in CT scans clearable by NEXUS criteria after 12 months. One of the studies reported that NEXUS criteria were a cost-effective option when used along with X-rays and CT. Overall, the studies do not strongly support the application of the NEXUS criteria to image pediatric patients for CSI. In conclusion, there is weak support in the literature for applying the NEXUS criteria in determining the need for cervical spine imaging in pediatric trauma patients. The practice and research implications of the findings are also discussed.

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Section: Introductionmentioning

confidence: 99%

Implementation of National Emergency X-Radiography Utilization Study (NEXUS) Criteria in Pediatrics: A Systematic Review

Ekhator¹,

Nwankwo²,

Nicol³

2022

Cureus

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Cervical spine

Laker

Stokes

2023

The Youth Athlete

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Pediatric Cervical Spine Trauma

Zhang,

Hongsermeier-Graves,

Savic

et al. 2024

Clinical Spine Surgery

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Study design Narrative review. Objective: To provide an updated overview of pediatric cervical spine trauma. Summary of background data: Pediatric cervical spine trauma can cause debilitating morbidity and mortality and neurological impairment. The unique anatomic features of the developing cervical spine can predispose children to injuries. Methods We reviewed the pediatric cervical spine trauma literature in PubMed and EMBASE. Results: Pediatric cervical spine injury occurs in 1%–2% of pediatric trauma. The most frequent cause is motor vehicle collisions, with sports-related injuries being more common in older children. Larger head-to-body ratios and tissue elasticity can predispose young children to a greater risk of injury higher in the craniocervical junction and cervical spine. Standardized protocols and classification systems, such as the Pediatric Cervical Spine Clearance Working Group protocol and the AO Spine Injury and Subaxial Cervical Spine Injury Classifications, are valuable in triage as well as for assessing the need for operative versus nonoperative management. In general, operative approaches and principles are similar to those in adults, with modern instrumentation and fusion techniques achieving high rates of successful arthrodesis. Conclusions: Effective management and treatment of pediatric cervical spine injuries depends on early and accurate diagnosis, a thorough understanding of pediatric spinal anatomy, and a versatile surgical armamentarium.

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Cervical Spine Injury in Children and Adolescents

Cited by 4 publications

References 31 publications

Implementation of National Emergency X-Radiography Utilization Study (NEXUS) Criteria in Pediatrics: A Systematic Review

Implementation of National Emergency X-Radiography Utilization Study (NEXUS) Criteria in Pediatrics: A Systematic Review

Cervical spine

Pediatric Cervical Spine Trauma

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