title: Cervical spine injuries and collar complications in severely injured paediatric trauma patients.
abstract: METHODS
  A retrospective registry review.
  
  
  OBJECTIVE
  To determine the incidence of cervical spine (CS) injuries and collar complications in severely injured paediatric trauma patients.
  
  
  METHODS
  Regional Trauma Centre, Children's Hospital.
  
  
  METHODS
  A retrospective review of 365 paediatric severe trauma patients (0-17 years), defined as an Injury Severity Score (ISS)≥12, admitted to the paediatric intensive care unit (PICU).
  
  
  RESULTS
  Clinically significant CS injuries occurred in 5% (n=18/365) of trauma patients, in 9% (n=13/149) of traumatic brain injury (TBI) patients and in 11% (n=6/56) of in-hospital trauma deaths. CS injuries were suspected before imaging in 33% (n=6/18) of patients based on either motor/sensory impairment or shock. CS injuries were deemed unstable in 61% (n=11/18) of patients. Patients with CS injuries had higher ISS, and longer PICU and hospital stays (P<0.05). CS collar complications occurred in 10% of patients, mainly identified by day 6 and consisting of either erythema or ulcers. Patients with CS collar complications were older and more likely to have TBI, lower Glasgow Coma Scale (GCS) scores, longer PICU and hospital stays, and increased days to CS clearance (P<0.05). Three CS X-rays, together with flexion/extension views, were used most frequently for CS clearance.
  
  
  CONCLUSIONS
  CS injuries were prevalent in severely injured paediatric trauma patients, particularly in those with TBI and in nonsurvivors. CS collar complications were associated with a lower GCS and longer CS clearance times. Attention to CS collar management protocols and earlier CS clearance with computed tomography/magnetic resonance imaging in obtunded patients might reduce CS collar complications.
authors: Paediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
authors: M
authors: M
authors: Chan
authors: W
authors: W
authors: Al-Buali
authors: T
authors: T
authors: Charyk Stewart
authors: R N
authors: RN
authors: Singh
authors: A
authors: A
authors: Kornecki
authors: J A
authors: JA
authors: Seabrook
authors: D D
authors: DD
authors: Fraser
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009984:Orthopedic Fixation Devices / Q000009:adverse effects*; D012149:Restraint, Physical / Q000379:methods*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000628:therapy*; D013124:Spinal Injuries / Q000453:epidemiology* / Q000628:therapy*