Management of cervical spine trauma in children

Copley, Phillip Correia; Tilliridou, Vicky; Kirby, Andrew; Jones, Jeremy; Kandasamy, Jothy

doi:10.1007/s00068-018-0992-x

Cited by 52 publications

(52 citation statements)

References 52 publications

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“…Paediatric patients suffering blunt trauma are always assessed for cervical spine injury (CSI) given the potential risk of morbidity and mortality [1][2][3]. However, CSI is rare, accounting for less than 2% of all children being evaluated after blunt trauma, even in higher risk populations presenting at level 1 trauma centres [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre

Brinke

Slinger

Slaar³

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Cervical spine injury after blunt trauma in children is rare but can have severe consequences. Clear protocols for diagnostic workup are, therefore, needed, but currently not available. As a step in developing such a protocol, we determined the incidence of cervical spine injury and the degree of protocol adherence at our level 2 trauma centre. Methods We analysed data from all patients aged < 16 years suspected of cervical spine injury after blunt trauma who had presented to our hospital during two periods: January 2010 to June 2012, and January 2017 to June 2019. In the intervening period, the imaging protocol for diagnostic workup was updated. Outcomes were the incidence of cervical spine injury and protocol adherence in terms of the indication for imaging and the type of imaging. Results We included 170 children in the first study period and 83 in the second. One patient was diagnosed with cervical spine injury. Protocol adherence regarding the indication for imaging was > 80% in both periods. Adherence regarding the imaging type decreased over time, with 45.8% of the patients receiving a primary CT scan in the second study period versus 2.9% in the first. Conclusion Radiographic imaging is frequently performed when clearing the paediatric cervical spine, although cervical spine injury is rare. Particularly CT scan usage has wrongly been emerging over time. Stricter adherence to current protocols could limit overuse of radiographic imaging, but ultimately there is a need for an accurate rule predicting which children really are at risk of injury.

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Section: Introductionmentioning

confidence: 99%

Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre

Brinke

Slinger

Slaar³

et al. 2020

Eur J Trauma Emerg Surg

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“…The surgical approach during fusion, however, is variable in the literature due to the smaller bone structure that may render traditional plates and screws unsuitable for implantation. Moreover, potential deformity, complications, and inhibition of normal spinal growth must be taken into consideration [ 17 ]. A study of seven patients undergoing axial or subaxial translaminar screw insertion utilizing allograft or iliac graft autograft achieved spinal fusion in all seven patients, with only one patient experiencing perioperative dysphagia thus demonstrating its efficacy and relative safety [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Cervical Pediatric Spine Trauma Managed With Open Spinal Fixation and Instrumentation and a Review of the Literature

Gigliotti¹,

Farou²,

Salyvia³

et al. 2021

Cureus

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Cervical spine injuries in the pediatric population are rare. Most injuries to the cervical spinal cord and vertebral column can be managed nonoperatively; however, surgical management may be required in certain clinical scenarios. A posterior surgical approach has been previously preferred; however, the utilization of anterior spinal fixation and instrumentation has been limited. We present a small case series of patients presenting with a traumatic cervical spine injury and detail the feasibility of craniocervical junction (CVJ) and subaxial spinal fixation in the pediatric population. We report four cases involving pediatric patients, all of whom presented with cervical spine injuries necessitating operative intervention using a combination of the anterior and posterior operative approaches. All four patients recovered well, did not require surgical revision, and were neurologically intact at the last follow-up. Therefore, we conclude that spinal arthrodesis is a safe, effective way to manage spinal injuries in the cervical spine following traumatic injury.

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“…The hospital is approximately a 1200-bed facility with all general and subspecialty medical services. The ED is considered a level-I emergency treatment facility opened round the clock (24 hours a day, seven days a week) where a level I ED facility is known as the "center that is capable of providing total care for every aspect of injury–from prevention through rehabilitation [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

Prescribing errors and associated factors in discharge prescriptions in the emergency department: A prospective cross-sectional study

et al. 2021

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Objectives Evidence regarding the prevalence of medication prescribing errors (PEs) and potential factors that increase PEs among patients treated in the emergency department (ED) are limited. This study aimed to explore the prevalence and nature of PEs in discharge prescriptions in the ED and identify potential risk factors associated with PEs. Methods This was a prospective observational cross-sectional study in an ambulatory ED in a tertiary teaching hospital. Data were collected for six months using a customized reporting tool. All patients discharged from ED with a discharged prescription within the study period were enrolled in this study. Results About 13.5% (n = 68) of the 504 prescriptions reviewed (for 504 patients) had at least one error. Main PEs encountered were wrong dose (23.2%), wrong frequency (20.7%), and wrong strength errors (14.6%). About 36.8% of identified PEs were related to pediatric prescriptions, followed by the acute care emergency unit (26.5%) and the triage emergency unit (20.6%). The main leading human-related causes associated with PEs were lack of knowledge (40.9%) followed by an improper selection from a computer operator list (31.8%). The leading contributing systems related factors were pre-printed medication orders (50%), lack of training (31.5%), noise level (13.0%), and frequent interruption of prescriber and distraction (11.1%). Prescribers' involved with the identified errors were resident physicians (39.4%), specialists (30.3%), and (24.4%) were made by general practitioners. Physicians rejected around 12% of the pharmacist-raised recommendations related to the identified PEs as per their clinical judgment. Conclusion PEs in ED setting are common, and multiple human and systems-related factors may contribute to the development of PEs. Further training to residents and proper communication between the healthcare professionals may reduce the risk of PEs in ED.

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Management of cervical spine trauma in children

Abstract: Due to a paucity of evidence in these rare conditions, expert opinion is necessary to guide best practice management and to ensure the best chance of a good outcome for the injured child.

Cited by 52 publications

References 52 publications

Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre

Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre

Cervical Pediatric Spine Trauma Managed With Open Spinal Fixation and Instrumentation and a Review of the Literature

Prescribing errors and associated factors in discharge prescriptions in the emergency department: A prospective cross-sectional study

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