In this hypothetical cohort, clinical clearance and screening plain radiography with focused CT use were preferred to a CT all strategy.Īrticle 2: Pannu GS, Shah MP, Herman MJ. Sensitivity analysis was utilized to balance missed injuries with malignancy risk. The study design uses a decision analysis tree, constructed from a literature-based hypothetical population. This is a novel study designed to determine the optimal method to screen for cervical spine injuries in blunt trauma patients younger than 19 years old. Link to article: Decision analysis pediatric Cspine Pediatric cervical spine injury evaluation after blunt trauma: a clinical decision analysis. Three recent publications contribute to our understanding of pediatric cervical spine management.Īrticle 1: Hannon M, Mannix R, Dorney K, Mooney D, Hennelly K. unstable” injuries, including age appropriate immobilization, neonatal spinal cord injuries, development of syringomyelia, and long term deformity from ligamentous cervical spine injuries. plain X-ray” is overly simplistic.įinally, this guideline addresses elements of pediatric cervical spine injury that go beyond the central concern of “stable vs. If nothing else, the section on imaging builds the case that the reductionism of “CT vs. Whatever your current practice, this section of the guideline is quite informative. Perhaps even better is that the section on imaging walks through the available evidence regarding the different modalities for the pediatric cervical spine. plain X-ray” controversy, it honestly does not. While it could be hoped that a guideline such as this would put to rest the “CT vs. This recommendation supports the practice of “clinically clearing” the cervical spine of children of all ages, as long as they are at low risk of cervical spine injury. These recommendations are supported at a Level II grade of evidence. In addition children 13 and an injury mechanism that is not motor vehicle collision (MVC), fall > 10 feet, or nonaccidental trauma (NAT). More commonly, this guideline speaks to the value of assessing the cervical spine of injured children WITHOUT the use of imaging, if certain criteria are met: alert, no neurological deficit, no midline tenderness, no painful distracting injury, no unexplained hypotension, and no intoxication. This is a thankfully rare, but quite serious injury. The solitary Level I recommendation involves the use of CT to determine the condyle-C1 interval in patients with atlantooccipital dislocation. It addresses several different facets of pediatric cervical spine management, including prehospital immobilization, imaging, and injury management. This recent guideline was developed by the American Association of Neurologic Surgeons (AANS) and the Congress of Neurological Surgeons (CNS). Link to guideline: PediatricCspineGuideline Management of pediatric cervical spine and spinal cord injuries. Rozzelle CJ, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, Ryken TC, Theodore N, Walters BC, Hadley MN. Nathan Kreykes MD, Shannon Longshore MD, and John Petty, MD Guidelines in Focus: Pediatric Cervical Spine
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