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Using cervical spine clearance guidelines in a pediatric population: a survey of physician practices and opinions

Published online by Cambridge University Press:  11 May 2015

Emma C. Burns  and
Natalie L. Yanchar
Emma C. Burns*
Affiliation:
Department of Pediatrics, IWK Health Centre, Halifax, NS
Natalie L. Yanchar
Affiliation:
Department of Pediatrics, IWK Health Centre, Halifax, NS
*
Department of Pediatric Emergency Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8C1; ecmburns@yahoo.ca.

Abstract

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Background:

Unlike in adults, there are currently no standardized, validated guidelines to aid practitioners in clearing the pediatric cervical spine (C-spine). Many pediatric centres in Canada have locally produced, adult-modified guidelines, but the extent to which these or other guidelines are used is unknown.

Objective:

The purpose of this study was to determine if Canadian physicians are using either locally produced or adult C-spine guidelines to clear the C- spines of patients < 16 years of age. The study also characterized the common methods used by physicians to clear pediatric C-spine injuries in terms of clinical examination and radiologic imaging.

Methods:

A 20-question survey was distributed to 240 Canadian pediatric emergency physicians and trauma team leaders using the Dillman Total Design Method.

Results:

The response rate was 68%. The results showed that 61% of physicians currently use guidelines to assist in the clearance of pediatric C-spines. Of those physicians not using guidelines, 85% stated that they would use them if they were available. The clinical criteria most often used to clear pediatric C-spines were a normal neurologic examination (97%) and the absence of C-spine tenderness (95%), intoxication (94%), and distracting injuries (87%).

Conclusions:

Guidelines are commonly used by Canadian physicians when clearing the pediatric C-spine, yet few are validated in children. Those most commonly used are locally developed guidelines, the Canadian C-spine guidelines, or National Emergency X-Radiography Utilization Study (NEXUS) low-risk criteria.

Keywords

Canadian C-Spine Rule studyCervical-SpineguidelinesNEXUSpediatric traumapractice variation
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 1 , January 2011 , pp. 1 - 6
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

References

REFERENCES

1.Brehaut, JC, Stiell, IG, Graham, ID. Will a new clinical decision rule be widely used? The case of the Canadian CSpine rule. Acad Emerg Med 2006;13:413–20.Google Scholar
2.Hoffman, JR, Mower, WR, Wolfson, AB, et al, for the National Emergency X-Radiography Utilization Study Group. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med 2000;343:94–9.CrossRefGoogle Scholar
3.Stiell, IG, Wells, GA, Vandemheen, KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 2001;286:1841–8.Google Scholar
4.Bandiera, G, Stiell, IG, Wells, GA, et al, for the Canadian CSpine and CT Head Study Group. The Canadian C-spine rule performs better than unstructured physician judgement. Ann Emerg Med 2003;42:395–402.Google Scholar
5.Viccellio, P, Simon, H, Pressman, BD, et al. A prospective multicenter study of cervical spine injury in children. Pediatrics 2001;108(2:)e20-6.CrossRefGoogle ScholarPubMed
6.Omran, HA, Dowd, M, Knapp, JF. Removing the pediatric cervical collar. Arch Pediatr Adolesc Med 2001;155:162–6.Google Scholar
7.Reilly, CW. Pediatric spine trauma. J Bone Joint Surg Am 2007;89A(Suppl 1):98–107.Google ScholarPubMed
8.Waltz, CF, Strickland, OL, Lenz, ER. Reliability and validity of criterion-references measures. In: Waltz, CF, editor. Measurement in nursing research. Philadelphia: FA Davis Company, 1986. p. 184–208.Google Scholar
9.Dillman, D. Mail and telephone surveys: The Total Design Method. New York: Wiley Interscience, 1978.Google Scholar
10.Platzer, P, Jaindl, M, Thalhammer, G, et al. Cervical spine injuries in pediatric patients. J Trauma 2007;62:389–94.Google Scholar
11.Kokosa, ER, Keller, MS, Rallo, MC, et al. Characteristics of pediatric cervical spine injuries. J Pediatr Surg 2001;36:100–5.Google Scholar
12.Anderson, RCE, Scaife, ER, Fenton, SJ, et al. Cervical spine clearance after trauma in children. J Neurosurg 2006; 105(5 Suppl):361–4.Google Scholar
13.Rana, AR, Drongowski, R, Breckner, G, et al. Traumatic cervical spine injuries: characteristics of missed injuries. J Pediatr Surg 2009;44:151–5.Google Scholar
14.Insko, EK, Gracias, VH, Gupta, R, et al. Utility of flexion and extension radiographs of the cervical spine in the acute evaluation of blunt trauma. J Trauma 2002;53:426–9.Google Scholar