Clearing the Paediatric C-Spine

2 June, 2011 by: colinparker

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Excluding a broken neck or a spinal cord injury: can be tricky. We know what to do when there is an obvious bony, ligamentous or cord injury… but do you want to be the one who takes responsibility to give the ‘all clear’?

Fortunately, serious injuries to the cervical spine, whether bony, ligamentous, or spinal cord injury, are uncommon in the really young… which is lucky for us, because these youngsters are also more difficult to assess – some clinicians feel uncomfortable trying to apply the NEXUS decision instrument in the under 3 year old age group. What evidence is out there, to guide our actions, for these children in our Emergency Departments and Intensive Care Units? Let’s try to weasel it out:


PEMcast Outline: Clearing the C-Spine

[CP/all] welcome, intro, disclaimer

[CP] Hoffman 2000: NEXUS

[CP] Canadian C-spine Rule 2001 (briefly) (& 2003 CCR vs NEXUS)

[KB] Viccellio 2001

[KB] McCarthy & Oakley 2002 (briefly)

[CP] Gary Browne 2003 CHW – use of adult protocols for kids?

[CP] Slack 2004 (briefly)

[KW] American Association Surgeons Trauma:  J Trauma 2009

[KB] Hutchings 2009 Review J Trauma

[CP] Hutchings 2009 J Trauma “protocol” (retrospective review)

[KW] Anderson 2010 March J Neurosurg Ped – protocol retrospective review

[CP] Kreykes 2010 November – review

[ALL] Summary, personal perspective, Goodbye


Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI.
Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt
trauma. National Emergency X-Radiography Utilization Study Group.
N Engl J Med. 2000 Jul 13;343(2):94-9. Erratum in: N Engl J Med 2001 Feb 8;344(6):464. PubMed
PMID: 10891516.

Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, Laupacis
A, Schull M, McKnight RD, Verbeek R, Brison R, Cass D, Dreyer J, Eisenhauer MA,
Greenberg GH, MacPhail I, Morrison L, Reardon M, Worthington J.
The Canadian C-spine rule for radiography in alert and stable trauma patients.
JAMA. 2001 Oct 17;286(15):1841-8. PubMed PMID: 11597285.

Stiell IG, Clement CM, McKnight RD, Brison R, Schull MJ, Rowe BH, Worthington
JR, Eisenhauer MA, Cass D, Greenberg G, MacPhail I, Dreyer J, Lee JS, Bandiera G,
Reardon M, Holroyd B, Lesiuk H, Wells GA.
The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma.
N Engl J Med. 2003 Dec 25;349(26):2510-8. PubMed PMID: 14695411.

Viccellio P, Simon H, Pressman BD, Shah MN, Mower WR, Hoffman JR; NEXUS Group.
A prospective multicenter study of cervical spine injury in children.
Pediatrics. 2001 Aug;108(2):E20. PubMed PMID: 11483830.

McCarthy C, Oakley E.
Management of suspected cervical spine injuries–the paediatric perspective.
Accid Emerg Nurs. 2002 Jul;10(3):163-9. PubMed PMID: 12443038.

Browne GJ, Lam LT, Barker RA.
The usefulness of a modified adult protocol for  the clearance of paediatric cervical spine injury in the emergency department.
Emerg Med (Fremantle). 2003 Apr;15(2):133-42. PubMed PMID: 12675623.

Slack SE, Clancy MJ.
Clearing the cervical spine of paediatric trauma patients.
Emerg Med J. 2004 Mar;21(2):189-93. Review. PubMed PMID: 14988345.

Pieretti-Vanmarcke R, Velmahos GC, Nance ML, Islam S, Falcone RA Jr, Wales PW, Brown RL, Gaines BA, McKenna C, Moore FO, Goslar PW, Inaba K, Barmparas G, Scaife ER, Metzger RR, Brockmeyer DL, Upperman JS, Estrada J, Lanning DA, Rasmussen SK, Danielson PD, Hirsh MP, Consani HF, Stylianos S, Pineda C, Norwood SH, Bruch SW, Drongowski R, Barraco RD, Pasquale MD, Hussain F, Hirsch EF, McNeely PD, Fallat ME, Foley DS, Iocono JA, Bennett HM, Waxman K, Kam K, Bakhos L, Petrovick L, Chang Y, Masiakos PT.
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.
J Trauma. 2009 Sep;67(3):543-9; discussion 549-50. PubMed PMID: 19741398.

Hutchings L, Willett K.
Cervical spine clearance in pediatric trauma: a review of current literature.
J Trauma. 2009 Oct;67(4):687-91. Review. PubMed PMID: 19820571.

Hutchings L, Atijosan O, Burgess C, Willett K.
Developing a spinal clearance protocol for unconscious pediatric trauma patients.
J Trauma. 2009 Oct;67(4):681-6. PubMed PMID: 19820570.

Anderson RC, Kan P, Vanaman M, Rubsam J, Hansen KW, Scaife ER, Brockmeyer DL.
Utility of a cervical spine clearance protocol after trauma in children between 0 and 3 years of age.
J Neurosurg Pediatr. 2010 Mar;5(3):292-6. PubMed PMID: 20192648.

Kreykes NS, Letton RW Jr.
Current issues in the diagnosis of pediatric cervical spine injury.
Semin Pediatr Surg. 2010 Nov;19(4):257-64. Review. PubMed PMID: 20889081.

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One Response to “Clearing the Paediatric C-Spine”
  1. Colin says:

    Leonard et al: PECARN study. 8 clinical features.


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