The usefulness of a modified adult protocol for the clearance of paediatric cervical spine injury in the emergency department.
OBJECTIVE
To determine if the use of a modified adult protocol that uses cervical spine imaging on presentation for the assessment of cervical spine injury in children improves clinical outcome.


METHODS
This is a case series study on all consecutive trauma patients presenting from April to July 2000 inclusive to the ED of a major paediatric trauma hospital. Children presenting to the ED with potential cervical spine injury (CSI) were identified using standard selection criteria. Patient demographics, mechanism of injury, method and time of presentation, associated injuries, radiological investigation and clinical outcome were recorded. The major outcome measures for this study were: time to clearance of the cervical spine, length of stay in the ED and admission to an in-hospital bed. Data were analysed for compliance to the protocol, this being the standard assessment pathway of cervical spine clearance used by our trauma service.


RESULTS
The trauma registry identified 1721 trauma presentations during the 4-month study period; 208 presentations representing 200 children with potential CSI were entered into the study. Males represented 72.5% of the study population, having a mean age of 8.32 years, although 29% were less than 5 years of age. The majority of presentations (69%) occurred outside of normal working hours. In 17.8% of cases the cervical spine was cleared based on clinical assessment alone, half less than 5 years of age. Compliance to the protocol occurred in 78% of presentations. However, when examined by age group, children 5 years of age or above were 1.5 times more likely to comply with the protocol as compared with younger children. Adequate plain imaging was not obtained in 18% of presentations, this group almost exclusively less than 5 years of age. There were no missed injuries and no short or long-term neurological sequelae reported during this study. There were no differences in time to clearance, length of stay and admission rate between compliant and non-compliant groups.


CONCLUSIONS
Modified adult protocols for cervical spine clearance offer guidance in managing the majority of children suffering blunt trauma. However, we recommend caution in rigidly applying such protocols, especially to children of young age.
Browne
Gary J
GJ
Department of Emergency Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia. garyb@chw.edu.au
Lam
Lawrence T
LT
Barker
Ruth A
RA
D000328:Adult; D000367:Age Factors; D000465:Algorithms; D002574:Cervical Vertebrae / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols / Q000592:standards*; D003663:Decision Trees; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods* / Q000592:standards; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006776:Hospitals, Pediatric; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013124:Spinal Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D014193:Trauma Centers