Utility of a cervical spine clearance protocol after trauma in children between 0 and 3 years of age

Anderson, Richard C. E.; Kan, Peter; Vanaman, Monique; Rubsam, Jeanne; Hansen, Kristine; Scaife, Eric R.; Brockmeyer, Douglas L.

doi:10.3171/2009.10.peds09159

Cited by 68 publications

(34 citation statements)

References 17 publications

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“…Anderson et al [18] devised a cervical spine clearance protocol specifically for children between 0 and 3 years of age. Their plan utilized some form of routine radiographic imaging combined with a thorough physical and neurological examination and, if applicable, neurosurgical input.…”

Section: Discussionmentioning

confidence: 99%

Identification of Risk Factors for Cervical Spine Injury from Pediatric Trauma Registry

et al. 2016

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Background: Cervical spine injuries are rare in children. Our goal is to establish guidelines for cervical spine clearance that are practical for our pediatric population, and, in the process, to reduce the risk of radiation exposure from unnecessary advanced imaging. Methods: We retrospectively reviewed the records from the registries of two pediatric trauma centers from the past 11 years (January 2002 to June 2013). Patients aged 1 month to 17 years, who had a CT scan of the cervical spine due to trauma indication for possible cervical spine injury, were evaluated. Results: Three risk factors were identified as being significant for the presence of a cervical spine injury. Patients who sustained a cervical spine injury were more likely to be male (p = 0.0261), were more severely injured with a higher injury severity score (ISS 16.39 ± 15.79 injured vs. 8.7 ± 9.4 uninjured), and presented with neck tenderness (p = 0.0001). Conclusion: In our study, significant cervical spine injury is related to male gender, higher ISS and neck tenderness.

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Section: Discussionmentioning

confidence: 99%

Identification of Risk Factors for Cervical Spine Injury from Pediatric Trauma Registry

et al. 2016

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“…In another study, somatosensory evoked potential monitoring was used during flexion-extension radiographs in a prospective study of 15 obtunded pediatric patients with inconclusive results [27]. Other recent work has focused on trauma protocols to either identify injuries or clear the cervical spine in children 0 to 3 years of age [2,23]. None of these studies, however, addresses the specific issue of determining the best radiographic protocol to clear the cervical spine in the obtunded or comatose pediatric trauma patient.…”

Section: Discussionmentioning

confidence: 99%

“…The patient inclusion criteria for the study were as follows: (1) Glasgow Coma Scale score of 8 or less after hemodynamic stabilization; (2) admitted to the intensive care unit; (3) greater than 2 weeks of age and less than 17 years of age; and (4) suspected or known traumatic cervical spine injury. The patient exclusion criteria included: (1) inability to obtain plain radiographs, CT, or MR imaging within 7 days of the patient's admission to the hospital (later amended to 10 days); (2) inability to obtain follow-up plain cervical spine radiographs 3-4 months after injury; or 3) isolated gunshot or penetrating wound to the head with little chance of cervical spine injury.…”

Section: Clinical Materials and Methodsmentioning

confidence: 99%

The pediatric cervical spine instability study

2012

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There was a low prevalence of cervical instability in this high-risk group. Plain radiographs, flexion-extension radiographs, and CT all had high sensitivities and specificities. MR imaging had a high false-positive rate, making it sensitive but not specific. The data support using either CT or plain radiographs as the initial cervical spine screening study, but CT is recommended because of its superior ability to detect critical injuries. To definitively rule out ligamentous instability after a negative screening CT scan or cervical spine X-ray, these data support using flexion-extension X-rays with fluoroscopy and not MR imaging.

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“…2,4,21,28,34,36,39 Clearing the spine of suspected injury is especially difficult in children because spine injuries are uncommon in this age group, children are often noncommunicative, and many normal variants are found in the pediatric spine, such as pseudosubluxation, synchondroses, and incomplete ossification. Recent studies have expanded the use of clinical decision rules, such as NEXUS and the Canadian C-spine Rule, to the pediatric population.…”

Section: Ct Imagingmentioning

confidence: 99%

“…In recent years, many published reports of new protocols devised to assess the pediatric cervical spine have been vague in their criteria or have used adult parameters. 2,3,7,12,26 This study aims to develop normal values, in a very preliminary fashion, for selected anatomical relationships in the pediatric upper cervical spine. Using these early numbers as a stepping stone, along with studies of their reliability, we hope to begin the process of establishing truly valid, reliable normal estimates for these measurements in children.…”

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confidence: 99%

Estimation of normal computed tomography measurements for the upper cervical spine in the pediatric age group

Vachhrajani

Sen

Satyan

et al. 2014

PED

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Object Upper cervical spine injuries in the pediatric age group have been recognized as extremely unstable from ligamentous disruption and as potentially lethal. Few measurement norms have been published for the pediatric upper cervical spine to help diagnose this pathological state. Instead, adult measurement techniques and results are usually applied inappropriately to children. The authors propose using high-resolution reconstructed CT scans to define a range of normal for a collection of selected upper cervical spine measurements in the pediatric age group. Methods Sagittal and coronal reformatted images were obtained from thin axial CT scans obtained in 42 children (< 18 years) in a 2-month period. There were 25 boys and 17 girls. The mean age was 100.9 months (range 1–214 months). Six CT scans were obtained for nontrauma indications, and 36 were obtained as part of a trauma protocol and later cleared for cervical spine injury. Six straightforward and direct linear distances—basion-dental interval (BDI); atlantodental interval (ADI); posterior atlantodental interval (PADI); right and left lateral mass interval (LMI); right and left craniocervical interval (CCI); and prevertebral soft-tissue thickness at C-2—that minimized logistical and technical distortions were measured and recorded. Statistical analysis including interobserver agreement, age stratification, and sex differences was performed for each of the 6 measurements. Results The mean ADI was 2.25 ± 0.24 mm (± SD), the mean PADI was 18.3 ± 0.07 mm, the mean BDI was 7.28 ± 0.10 mm, and the mean prevertebral soft tissue width at C-2 was 4.45 ± 0.43 mm. The overall mean CCI was 2.38 ± 0.44 mm, and the overall mean LMI was 2.91 ± 0.49 mm. Linear regression analysis demonstrated statistically significant age effects for PADI (increased 0.02 mm/month), BDI (decreased 0.02 mm/month), and CCI (decreased 0.01 mm/month). Similarly significant effects were found for sex; females demonstrated on average a smaller CCI by 0.26 mm and a smaller PADI by 2.12 mm. Moderate to high interrater reliability was demonstrated across all parameters. Conclusions Age-dependent and age-independent normal CT measurements of the upper cervical spine will help to differentiate physiological and pathological states in children. The BDI appears to change significantly with age but not sex; on the other hand, the LMI and ADI appear to be age-independent measures. This preliminary study suggests acceptable levels of interrater reliability, and further expanded study will aim to validate these measurements to produce a profile of normal upper cervical spine measurements in children.

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Utility of a cervical spine clearance protocol after trauma in children between 0 and 3 years of age

Cited by 68 publications

References 17 publications

Identification of Risk Factors for Cervical Spine Injury from Pediatric Trauma Registry

Identification of Risk Factors for Cervical Spine Injury from Pediatric Trauma Registry

The pediatric cervical spine instability study

Estimation of normal computed tomography measurements for the upper cervical spine in the pediatric age group

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