This is a review of a retrospective, single center review of cervical spine injuries at a level one trauma center from 1998 to 2010 in children ages 0-5 years old.
Why do I care?
Cervical spine injuries are something we worry about and evaluate for nearly every day, whether we are on trauma or in the department. Although we have pretty good guidelines and are comfortable with the approach to the adult patient, there is more of a gray area when it comes to kids. Factor in the very young, preverbal or potentially unreliable exams one can experience in this age group, and the task is more challenging. This article sheds some light on the topic.
What do I need to know?
The pediatric cervical spine is different than adults. With a proportionally larger head, weak neck muscles, higher fulcrum of flexion/extension (C2-C3 versus C5-C6) than adults, horizontally oriented facet joints, kids can be higher risk for injury.
However CSI in children is rare. Over this extended time period, only 22 out of 2972 (0.74%) pediatric trauma patients were found to have CSI. The most common mechanism of injury was MVC. Of those injured children, 50% died. Most children had a GCS of 3, and many had other significant injuries. All children with CSI were found to have an abnormal exam, with the majority having a neurological deficit. Others had neck pain or torticollis. The authors also mentioned all asymptomatic children who were able to be evaluated (not in a coma) did not have an unstable CSI.
What do I need to do?
You need to know this information because this, as well as other articles, suggests that peds with a normal exam have a very low risk of CSI and therefore do not require imaging. Further, the authors emphasize that if there is still a need for imaging, it should begin with XR and not CT. This is much in line with the current guidelines on the approach to pediatric blunt neck trauma. If you would like to develop your own take, the reference for the article is listed below and is still available through the library. Till next time...
Hale DF, Fitzpatrick CM, Doski JJ, Stewart RM, Mueller DL. Absence of clinical findings reliably excludes unstable cervical spine injuries in children 5 years or younger. Journal of Trauma and Acute Care Surgery. 2015; 78(5): 943-948.
Submitted by Dr. Michael Craddick, PGY-1