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

Abstract

Background: Unlike in adults, there are currently no standardized, validated guidelines to aid practitioners in clearing the pediatric cervical spine (C-spine). Many pediatric centres in Canada have locally produced, adult-modified guidelines, but theextent towhichtheseorotherguidelinesareusedisunknown. Objective: The purpose of this study was to determine if Canadian physicians are using either locally produced or adult C-spine guidelines to clear the C-spines of patients , 16 years of age. The study also characterized the common methods used by physicians to clear pediatric C-spine injuries in terms of clinical examination and radiologic imaging. Methods: A 20-question survey was distributed to 240 Canadian pediatric emergency physicians and trauma team leaders using the Dillman Total Design Method. Results: The response rate was 68%. The results showed that 61% of physicians currently use guidelines to assist in the clearance of pediatric C-spines. Of those physicians not using guidelines, 85% stated that they would use them if they were available. The clinical criteria most often used to clear pediatric C-spines were a normal neurologic examination (97%) and the absence of C-spine tenderness (95%), intoxication (94%), and distracting injuries (87%). Conclusions: Guidelines are commonly used by Canadian physicians when clearing the pediatric C-spine, yet few are validated in children. Those most commonly used are locally developed guidelines, the Canadian C-spine guidelines, or National Emergency X-Radiography Utilization Study (NEXUS) low-risk criteria.

Imaging, Clearance, and Controversies in Pediatric Cervical Spine Trauma

“…A survey of 240 pediatric emergency physicians and trauma team leaders in Canada found that those trained in emergency medicine and critical care are more likely than those trained in family medicine or pediatrics to use a guideline. 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.…”

Pediatric Cervical Spine Injury Evaluation After Blunt Trauma: A Clinical Decision Analysis

“…7 Thus, clinicians remain uncertain about which clinical screening criteria, if any, to use when evaluating children for potential cervical spine injury after blunt trauma. 8,9 For the symptomatic patient, it is generally agreed that radiographic imaging is a necessary adjunct, but there are no consistent recommendations on indications or modality. Adult…”

Pediatric Spinal Traumas

“…Although childhood trauma is a major cause of mortality and morbidity, the incidence of spinal trauma is significantly lower in children than in adults [1]. Pediatric spinal trauma (PST) comprises 1–10% of all spinal injuries [2].…”