1. Cervical Spine Clearance in Pediatric Trauma Centers: The Need for Standardization and an Evidence-Based Protocol
Mitesh Shah MD
Martin J Herman MD
Jonathan Phillips MD, Chair of the
Pediatric Cervical Spine Study Group

2. Introduction Cervical spine injuries uncommon
1-2% incidence
Devastating consequences
Death
Paralysis
Evaluation of cervical spine injuries begins with cervical spine clearance
Efficient and safe clearance of the uninjured patient
Limit radiation exposure
Identification of injured patients

3. Literature on Pediatric Cervical Spine Clearance Protocols
NO Consensus
Trauma Surgery and Neurosurgery literature
Awake child vs obtunded child
Radiographs vs CT
Standardized protocol
J Trauma, 2009
J Trauma, 2011

4. Starting Point for this Study
191 centers
57% had written cervical spine spine clearance protocols
Varied imaging strategies
Concluded
Need for standardization
dailyrecord.co.uk

5. Methods
Electronic survey of members of the Pediatric Cervical Spine Study Group
10 questions
FREE
Key Questions
Who clears the cervical spine for pediatric trauma patients?
What imaging modalities are used for cervical spine clearance?
Does the institution have a written cervical spine clearance protocol?

6. Results 27 surgeons answered the survey 25 different centers
Eliminated 2 surveys
same institution
25 different centers
21 LEVEL ONE centers
4 LEVEL TWO centers
All centers with an academic affiliation

7. Who clears the cervical spine for pediatric trauma patients?
SPINE Consult Service
63% Rotating Schedule
Orthopedic Surgery
Neurosurgery
30% Orthopedic Surgery
7% Neurosurgery

8. What imaging modalities are used for cervical spine clearance?
All had FULL-time access to CT
80% FULL-time access to MRI

9. Does your institution have a written cervical spine clearance protocol?
Only 46 % of centers had a written standardized pediatric cervical spine clearance protocol

10. Limitations Small sample size Survey Relevance of information
Questions open to interpretation
Recall bias
Relevance of information
Is there a need for improvement of current clearance methods when the rate of missed injury is low?

11. Conclusions Pediatric cervical spine clearance protocols
Vary widely among institutions
Personnel assessing patients
Imaging modalities
Standardized, written clearance protocols are NOT used by the majority of institutions
FUTURE consideration should be given to creating and validating a standardized protocol for Cervical Spine clearance in children

12. References Selected References
Eubanks J, Gilmore A, Bess S, Cooperman D: Clearing the Pediatric Cervical Spine Following Injury.Journal of the American Academy of Orthopedic Surgeons 2006;14:
Hannon M, Mannix R, Dorney K, Mooney D, Hennelly K. Pediatric Cervical Spine Injury Evaluation After Blunt Trauma: A Clinical Decision Analysis. Ann Emerg Med Oct 16. pii: S (14) (Epub ahead of print).
Henry M, Scarlata K, Riesenburger RI, Kryzanski J, Rideout L, Samdani A, Jea A, Hwang SW: Utility of STIR MRI in Pediatric Cervical Spine Clearance after Trauma. Journal of Neurosurgery: Pediatrics 2013;12(1):
Jones TM, Anderson PA, Noonan KJ: Pediatric Cervical Spine Trauma. Journal of the American Academy of Orthopedic Surgeons 2011;19:
Kreykes NS, Letton, Jr RW: Current Issues in the Diagnosis of Pediatric Cervical Spine Injury. Seminars in Pediatric Surgery 2010;19:
Leonard JR, Jaffe DM, Kuppermann N, Olsen CS, Leonard JC; Pediatric Emergency Care Applied Research Network (PECARN) Cervical Spine Study Group. Cervical spine injury patterns in children. Pediatrics May;133(5):e doi: /peds
Puisto V, Kaarianen S, Impinen A, et al: Incidence of spinal and spinal cord injuries and their surgical treatment in children and adolescents: A population based study. Spine (Phila 1976). 2010;35:
Sun R, Skeete D, Wetjen K, Lilienthal M, Liao J, Madsen M, Lancaster G, Shilyansky J, Choi K. A pediatric cervical spine clearance protocol to reduce radiation exposure in children. J Surg Res Jul;183(1): (Epub 2013 Jan 16).
Vanderhave K, Chiravuri S, Caird M, Farley F, Graziano G, Hensinger R, Patel R: Cervical Spine Trauma in Children and Adults: Perioperative Considerations. Journal of the American Academy of Orthopedic Surgeons 2011;19: