A multidisciplinary approach to the development of a cervical spine clearance protocol: Process, rationale, and initial results

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

“…Other clinical, pediatric, predictive models [6,17,19] have shown an ability to reduce unnecessary radiological imaging in children who are at low risk of cervical spine injury with blunt trauma. Among these studies, Leonard et al [6] identified 8 factors associated with cervical spine injury (PECARN - Pediatric Emergency Care Applied Research Network).…”

Anterior Atlantodental and Posterior Atlantodental Intervals on Plain Radiography, Multidetector CT, and MRI

“…MRI shows the spinal cord itself, and the visualization of the cord allows clinicians to determine whether the cord is at risk for, or compressed. MRI can also reveal isolated ligamentous injury, spinal cord contusion, and complex injuries of the occipitoatlantal joint capsule and craniocervical ligaments (16)(17)(18)(19). However, MRI does not permit close cardiovascular monitoring and ventilation support of the traumatized patients during data acquisition (17).…”

“…Recently, the multidetector CT (MDCT) scan has replaced plain radiography as the primary radiological examination type in emergency situations in many hospitals, including our institution. It has been considered the standard modality for the diagnosis of cervical spine injuries (15)(16)(17)(18)(19)(20). More recent studies have claimed that the MRI should be used for complete cervical clearance in all blunt trauma patients (16)(17)(18)(19) A 180-mm field of view (FOV), 512 × 512 matrix, 120 kVp, and 100 mAs were routinely used.…”

Cervical Spine Injuries in Children, Part I: Mechanism of Injury, Clinical Presentation, and Imaging

“…The American Association of Neurological Surgeons (AANS) recommends application of the NEXUS criteria in children over 9 years of age; in children who are alert, who have no neurologic deficit, midline C-spine tenderness, painful distracting injury, or intoxication, imaging is not required (26). Meanwhile, Lee et al attempted to create consensus guidelines incorporating the various strategies employed in different disciplines (27). To increase the sensitivity of detecting injuries in children, they suggested expanding the criteria and imaging the C-spine whenever the NEXUS criteria were present or there was significant mechanism of injury, a history of transient neurologic symptoms or physical evidence of neck trauma, significant trauma to the head or face, or the child was inconsolable (27).…”