Pediatric Cervical Spine Injury Sustained in Falls From Low Heights

Schwartz, Gary; Wright, Seth W.; Fein, Joel A.; Sugarman, Jacqueline M.; Pasternack, Joel S.; Salhanick, Steven D.

doi:10.1016/s0196-0644(97)70157-4

Cited by 27 publications

(9 citation statements)

References 10 publications

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“…The third child with a cervical spine fracture identified had a seemingly innocent mechanism of injury, a fall from a bunk bed. There have been similar reports in the literature of low‐impact injuries resulting in cervical spine fracture and neurological impairment 15,18 . One report suggests that lower CSI may be a common site of cervical spine injury in children, and fractures are the most common type of injury.…”

Section: Discussionmentioning

confidence: 80%

“…In studies evaluating outcome, retrospective data are used in children with defined CSI, representing the most severe end of the spectrum of injury 12–15 . There have been only a few studies analysing missed diagnoses of CSI in children and no studies that include children in whom clinical clearance of the cervical spine occurred 16–18 . Recent studies report the effectiveness in assessing adult trauma for CSI by risk‐stratifying patients on presentation 19,20 .…”

Section: Introductionmentioning

confidence: 99%

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The usefulness of a modified adult protocol for the clearance of paediatric cervical spine injury in the emergency department

2003

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Objective: To determine if the use of a modified adult protocol that uses cervical spine imaging on presentation for the assessment of cervical spine injury in children improves clinical outcome. Methods: This is a case series study on all consecutive trauma patients presenting from April to July 2000 inclusive to the ED of a major paediatric trauma hospital. Children presenting to the ED with potential cervical spine injury (CSI) were identified using standard selection criteria. Patient demographics, mechanism of injury, method and time of presentation, associated injuries, radiological investigation and clinical outcome were recorded. The major outcome measures for this study were: time to clearance of the cervical spine, length of stay in the ED and admission to an in‐hospital bed. Data were analysed for compliance to the protocol, this being the standard assessment pathway of cervical spine clearance used by our trauma service. Results: The trauma registry identified 1721 trauma presentations during the 4‐month study period; 208 presentations representing 200 children with potential CSI were entered into the study. Males represented 72.5% of the study population, having a mean age of 8.32 years, although 29% were less than 5 years of age. The majority of presentations (69%) occurred outside of normal working hours. In 17.8% of cases the cervical spine was cleared based on clinical assessment alone, half less than 5 years of age. Compliance to the protocol occurred in 78% of presentations. However, when examined by age group, children 5 years of age or above were 1.5 times more likely to comply with the protocol as compared with younger children. Adequate plain imaging was not obtained in 18% of presentations, this group almost exclusively less than 5 years of age. There were no missed injuries and no short or long‐term neurological sequelae reported during this study. There were no differences in time to clearance, length of stay and admission rate between compliant and non‐compliant groups. Conclusions: Modified adult protocols for cervical spine clearance offer guidance in managing the majority of children suffering blunt trauma. However, we recommend caution in rigidly applying such protocols, especially to children of young age.

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Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

The usefulness of a modified adult protocol for the clearance of paediatric cervical spine injury in the emergency department

2003

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“…When they did occur, the child demonstrated clinical evidence of injury, such as neck pain or limited range of motion, and suggested that the clinician may not need to perform radiographic evaluation in the asymptomatic child. 13 The results of our audit suggest you should not rely solely on the NEXUS criteria to predict cervical spine injury in children. Seven of the 21 patients did not meet any of the criteria, although in the older age group, 10 of 14 met at least one criteria at presentation.…”

Section: National Emergency X-radiography Utilization Study (Nexus)mentioning

confidence: 95%

Paediatric cervical spine injuries: An audit of 22 acute injuries and literature review

Watson

Upadhyay

2005

Injury Extra

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“…Four major pediatric trauma centers reviewed their combined cervical spine injuries following fall from less than 5 ft in preelementary patients. 19 Only eight children were identified with cervical spine injuries, but every one of them had neck pain or limited range of neck motion. In a smaller retrospective study of the NEXUS criteria in 187 pediatric patients with cervical spine injury and adequate records for review, Garton et al 20 reported two patients with significant cervical spinal injuries with NEXUS low-risk criteria.…”

Section: Discussionmentioning

confidence: 99%

Absence of clinical findings reliably excludes unstable cervical spine injuries in children 5 years or younger

Hale

Fitzpatrick

Doski

et al. 2015

Journal of Trauma and Acute Care Surgery

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Pediatric Cervical Spine Injury Sustained in Falls From Low Heights

Cited by 27 publications

References 10 publications

The usefulness of a modified adult protocol for the clearance of paediatric cervical spine injury in the emergency department

The usefulness of a modified adult protocol for the clearance of paediatric cervical spine injury in the emergency department

Paediatric cervical spine injuries: An audit of 22 acute injuries and literature review

Absence of clinical findings reliably excludes unstable cervical spine injuries in children 5 years or younger

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