title: Using cervical spine clearance guidelines in a pediatric population: a survey of physician practices and opinions.
abstract: 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.
authors.affiliation: Department of Pediatrics, IWK Health Centre, Halifax, NS, Canada. ecmburns@yahoo.ca
authors.forename: Emma C
authors.initials: EC
authors.lastname: Burns
authors.forename: Natalie L
authors.initials: NL
authors.lastname: Yanchar
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada; D002574:Cervical Vertebrae / Q000293:injuries*; D004636:Emergency Service, Hospital; D019983:Guideline Adherence; D019538:Health Care Surveys; D006302:Health Services Research; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013124:Spinal Injuries / Q000175:diagnosis*; D011795:Surveys and Questionnaires