Outcomes of pediatric patients with persistent midline cervical spine tenderness and negative imaging result after trauma

Dorney, Kate; Kimia, Amir A.; Hannon, Megan; Hennelly, Kara; Meehan, William P.; Proctor, Mark R.; Mooney, David P.; Glotzbecker, Michael; Mannix, Rebekah

doi:10.1097/ta.0000000000000847

Cited by 7 publications

(3 citation statements)

References 22 publications

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“…The use of cervical spine radiographs and computed tomography is common during trauma evaluation, [14][15][16] but most children who undergo screening do not have CSI. 10 With 90% sensitivity of cervical spine x-rays to detect CSI after blunt trauma in children, 8,9,17 its use in low-risk populations, as suggested in this study, is recommended. 8 In 2018, a telehealth/virtual option was established by our center to serve the wide geographic region covered by our trauma center.…”

Section: Discussionmentioning

confidence: 96%

The Fate of the Cervical Collar

Hewes¹,

Ravindra²,

Ryan³

et al. 2022

Pediatr Emer Care

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ObjectivesAfter evaluation and treatment of minor traumatic cervical spine injury (CSI), many children are discharged home in a rigid cervical orthosis (RCO). This study investigated their adherence to RCO treatment recommendations. The feasibility of telehealth cervical spine clearance was also explored.MethodsThis was a prospective observational study of children 3 to 18 years old with mild CSI evaluated at a level I pediatric trauma center from December 1, 2019, through July 31, 2021. Before emergency department discharge, patients received RCO use instructions and recommendation for follow-up with in-person neurosurgery clinic visit, neurosurgery telehealth visit, or in-person primary care provider visit. The family was responsible for arranging follow-up. Primary outcomes included compliance with follow-up and collar use.ResultsNinety-eight children (mean age, 11.3 ± 4.1 years) were included. Overall, follow-up contact was available for 51 patients (52%). At 1-week follow-up with 36 children, 64% were collar compliant, 13 had no pain (38% remained in RCO), 14 had mild pain without limitations, 8 had pain with some limitations, and 1 had significant pain. At 2-week follow-up with 31 children, 9 (29%) were collar compliant, 23 had no pain, 7 had mild pain without limitations, and 1 with significant persistent pain was found to have an odontoid fracture requiring C1–2 fusion. Patients/families often discontinued the use of the collar without follow-up (47%). Approximately half utilized a recommended clinical follow-up option for clearance, most often in neurosurgery clinic or using a neurosurgery telehealth visit. The mean time to follow-up was 11.34 ± 4.9 days (range, 3–25 days), and mean collar compliance lasted 9.8 ± 5.7 days (range, 1–25 days). No child experienced any short-term complications related to RCO use.ConclusionsIn this pilot study, a substantial portion of children with mild CSIs discharged from the emergency department with an RCO did not adhere to compliance or follow-up recommendations. Persistent pain requires further evaluation.

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Section: Discussionmentioning

confidence: 96%

The Fate of the Cervical Collar

Hewes¹,

Ravindra²,

Ryan³

et al. 2022

Pediatr Emer Care

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“… 13 Strong evidence-based guidelines for pediatric patients addressing collar use or subspecialty referral for follow-up do not exist. Patients discharged with cervical collars for persistent midline cervical tenderness are very unlikely to experience new onset instability or spinal cord injury in the absence of Xray or CT findings, 22 and prolonged use of immobilization for cervicalgia alone may lead to prolonged symptoms. 23 In this study, patients with neck pain and soft tissue injury on MRI were less likely to have their cervical spine cleared before discharge, but there was no effect of duration of neurologic complaint at presentation upon likelihood of cervical collar at discharge.…”

Section: Discussionmentioning

confidence: 99%

Relationship of cervical soft tissue injury and surgical predication following pediatric cervical spinal trauma and its sequelae on long-term neurologic outcome

Hect

McDowell

Fields

et al. 2023

World Neurosurgery: X

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“…Few studies have evaluated the outcomes of patients discharged with a cervical collar, and most have focused on outpatient MRI results. Dorney et al reviewed pediatric patients with persistent tenderness and found that 2.1% had MRI findings related to injury on follow-up, but none required surgery [ 11 ]. Kongsted et al prospectively followed 173 adults with neck pain and negative MRI imaging and showed that 0.5% of patients had traumatic cervical disc bulge or protrusion on repeat MRI imaging, but again, none required operative intervention [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Patients With Negative Cervical Imaging but Persistent Neck Tenderness Discharged With a Rigid Collar After Trauma

Randall¹,

Egbert²,

Ito³

et al. 2022

Cureus

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Introduction It is not uncommon for patients with persistent neck pain after trauma despite negative cervical imaging to be discharged with a rigid collar. Protocols for these patients vary widely. Few studies have evaluated clinical outcomes after discharge. No studies have evaluated the patient’s experience in a cervical collar after discharge. Methods We evaluated adults with blunt trauma and negative cervical spine imaging who were discharged in a rigid cervical collar. Over a 19-month period, 45 patients were available for analyses. The primary outcome was any identified missed injuries after discharge. Secondary outcomes were the incidence of patients self-clearing from their collars and complications related to wearing a collar. Results There were no missed traumatic injuries on follow-up imaging. Twenty of 45 patients cleared themselves from the collar without a physician order. Twenty-four patients had their collars removed by a provider in the clinic between 1-84 days after injury. One patient removed the collar after being advised by a chiropractor. More than half of patients reported one or more complications from wearing the cervical collar including pain, skin irritation, problems sleeping, difficulty talking or swallowing. Conclusions Collar complications are frequent. Follow-up imaging did not change outpatient management. Our data suggests against the practice of discharging trauma patients home in a cervical collar with negative imaging and no focal neurologic deficit.

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Outcomes of pediatric patients with persistent midline cervical spine tenderness and negative imaging result after trauma

Abstract: Therapeutic study, level IV.

Cited by 7 publications

References 22 publications

The Fate of the Cervical Collar

The Fate of the Cervical Collar

Relationship of cervical soft tissue injury and surgical predication following pediatric cervical spinal trauma and its sequelae on long-term neurologic outcome

Outcomes of Patients With Negative Cervical Imaging but Persistent Neck Tenderness Discharged With a Rigid Collar After Trauma

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