Removing the Pediatric Cervical Collar

Abstract

Discontinuing CSI without obtaining radiographs is common, especially among those with residency training in pediatrics and those in practice for less than 10 years. Knowledge of current practice is essential to future development of guidelines for managing pediatric trauma patients for whom cervical spine injury is a consideration.

Imaging, Clearance, and Controversies in Pediatric Cervical Spine Trauma

“…33 A survey conducted before the publication of the NEXUS and CCR criteria found that physicians trained in either pediatrics or pediatric emergency medicine were twice as likely to clear a patient with a reassuring examination without using radiographs when compared with emergency medicine-trained physicians. 34 Overall, pediatric practice of clearing cervical spine injuries is highly variable among providers and institutions. 35 This variability in practice has led several institutions to develop cervical spine clearance protocols for children.…”

Variation in the Self-Reported Use of Computed Tomography in Clearing the Cervical Spine of Pediatric Trauma Patients

“…The rate of clinical clearance was similar between general emergency physicians and pediatric emergency physicians. Our observed rate of self-reported clinical clearance, although approximate to a previously published self-reported clearance rate of 63%, 22 was surprising as it was our intent to create a clinical scenario of a young child for whom current guidelines recommend radiographic evaluation. 7,23 The unexpected rate of clinical clearance may be explained by several factors.…”

Using cervical spine clearance guidelines in a pediatric population: a survey of physician practices and opinions

“…6 There was also no significant difference in terms of how often these groups use plain radiography or CT for investigating patients not cleared clinically. We had hypothesized that some physicians might go directly to CT to image the C-spine in those patients also requiring head imaging, yet 79% of respondents said that they ''almost never'' or only ''occasionally'' used CT under these circumstances.…”

“…Despite the lack of clear guidelines, a survey of 1,360 physicians from the American Academy of Pediatrics and the American College of Emergency Physicians found that 63% of respondents reported that they would clear the C-spine of a 3-year-old comfortably without radiography. 6 Recognizing the need to provide guidance for physicians assessing potential C-spine injuries in patients less than 16 year of age, 8 of the 13 pediatric tertiary care hospitals in Canada have produced local guidelines (N.L.Y., unpublished data, 2006). This study revealed that of the physician groups sampled, at least half are using either locally modified adult guidelines or the most widely used adult tools (Canadian C-Spine Rules or NEXUS criteria) to clinically clear the C-spines of children of all ages, despite their not being valid for all ages.…”

“…Because of the variation in maturity and cooperation of children, physicians might vary their practice with each patient as opposed to following strict guidelines when assessing adults. 6 Also, many obstacles may hinder the development of validated pediatric-specific C-spine clearance guidelines. Low rates of injury make systematic research and guideline validation difficult.…”