Clinical clearance and imaging for possible cervical spine injury in children in the emergency department: A retrospective cohort study

Abstract

Background: While cervical spine injuries are rare in the paediatric population, presentations to emergency departments (ED) with possible neck injuries are common. Data regarding imaging rates and incidence of injuries are lacking. Objectives: We set out to to determine how many possible injuries are clinically cleared, what imaging is used on the remainder and the incidence and characteristics of confirmed paediatric cervical spine injuries. Methods: We undertook a retrospective electronic medical record review of children <18 years with potential cervical spine injuries at a large tertiary paediatric trauma centre in Victoria, Australia over a 12-month period (annual census 87 000). For possible injuries we extracted key epidemiologic, imaging and short-term outcome data. Findings: During the study period, a total of 617 patients with potential neck injuries were seen in the ED (617/87000 0.7%). The median age was 11 years. The most common mechanisms of injury were falls (41%), motor vehicle injuries (28%) and sports-related injuries (24%). 414/617 (67%) underwent neck imaging (345/414 83% plain radiograph, 100/414 24% computed tomography, 7/414 1.6% magnetic resonance imaging). 23/617 (4.1%) had radiologically documented cervical spine injuries. Two required operative interventions for their neck injuries. Conclusion: While two-thirds of children with potential cervical spine injuries undergo radiological evaluation, actual injuries are rare (<4%). These data suggest that there is a potential for improved targeting of cervical spine imaging for trauma. The development of a clinical decision tool may help reduce neck radiography.L6318769362020-06-02 <br />