Ham W, Schoonhoven L, Schuurmans MJ, Leenen LPH. Cervical spine injury patterns in children. Pediatric Emergency Care Applied Research Network (PECARN) cervical spine study group. Leonard JR, Jaffe DM, Kuppermann N, Olsen CS, Leonard JC. Factors associated with cervical spine injury in children after blunt trauma. Leonard JC, Kuppermann N, Olsen C, Babcock-Cimpello L, Brown K, Mahajan P, et al. Spine trauma in very young children: a retrospective study of 206 patients presenting to a level 1 pediatric trauma center. Knox JB, Schneider JE, Cage JM, Wimberly RL, Riccio AI. Cervical spine imaging for young children with inflicted trauma: expanding the injury pattern. 2017 219:366–73.īaerg J, Thirumoorthi A, Vannix R, Taha A, Young A, Zouros A. Cervical spine injuries in young children: pattern and outcomes in accidental versus inflicted trauma. 2001 36:373–6.īaerg J, Thirumoorthi A, Hazboun R, Vannix R, Krafft P, Zouros A. Pediatric cervical spine injuries: defining the disease. Patel JC, Tepas JJ, Mollitt DL, Pieper P. A prospective multicenter study of cervical spine injury in children. Viccellio P, Simon H, Pressman BD, Shah MN, Mower WR, Hoffman JR, et al. Clinical clearance of the cervical spine in blunt trauma patients younger than 3 years: a multi-center study of the American Association for the Surgery of Trauma. Pieretti-Vanmarcke R, Velmahos GC, Nance ML, Islam S, Falcone RA Jr, Wales PW, et al. Detection of pediatric cervical spine injury. Overview of pediatric emergency department visits, 2015. Papers of particular interest, published recently, have been highlighted as: When advanced imaging is sought, spine specialist consultation is recommended. Interval re-examination may be performed, as many patients will have resolution of pain and can then be cleared clinically without advanced cross-sectional imaging. A period of observation and cervical collar stabilization is appropriate for most patients without overt evidence of severe cervical spine trauma. Most pediatric trauma patients do not require advanced imaging (CT or MRI) to clear the cervical spine. Suspected or confirmed victims of nonaccidental trauma should undergo MRI of the cervical spine, as it may aid in confirming the mechanism of injury and identify non-bony injuries that would otherwise go unnoticed. High-resolution computed tomography (CT) of the cervical spine is superior to plain films in ruling out cervical spine injury and approaches the sensitivity of magnetic resonance imaging (MRI). Patients with negative imaging and persistent neck pain can be safely discharged home in a cervical collar with outpatient follow-up. Removal of the cervical collar without imaging is appropriate for most asymptomatic patients that are conscious and neurologically intact. The primary goal of this review is to synthesize an algorithm for cervical spine clearance using the best available evidence. In this review, we examine the current evidence-based practices in cervical spine evaluation and imaging in injured children, with an emphasis on criteria for cervical collar removal.
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