title: Adherence to the guidelines of paediatric cervical spine clearance in a level I trauma centre: A single centre experience.
abstract: BACKGROUND
  International guidelines define if and what type of radiography is advised in children to clear the cervical spine (C-spine). However, adherence to these guidelines has never been evaluated in a paediatric population. Therefore, we wanted to assess the adherence to the guidelines for C-spine clearance in a level-one trauma centre.
  
  
  METHODS
  We retrospectively included all children, presented at the ED between January 2006 and December 2013, in whom radiographic imaging of the C-spine was obtained following blunt trauma. Primary outcome was the adherence to the international guidelines with regard to (1) if the indication for radiographic imaging was correct and (2) if the type of radiographic imaging was correct.
  
  
  RESULTS
  Included were 573 patients; 336 boys (58.7%). Median age was 11 years (IQR 5.25-15). The indication for radiographic imaging was correct in all cases. The type of primary imaging modality was concordant with the guidelines in 99,7%. In 41% of the cases supplementary radiographs were made. The most common supplementary view was the odontoid. In 15% an incomplete set of radiographs was obtained.
  
  
  CONCLUSIONS
  The adherence to the international guidelines when to obtain radiographic imaging was 100%. However, in a large proportion of patients (56%), not the recommended number of radiographs was obtained.
authors.affiliation: Department of Radiology, The Netherlands. Electronic address: a.slaar@amc.nl.
authors.forename: Annelie
authors.initials: A
authors.lastname: Slaar
authors.affiliation: Department of Radiology, The Netherlands. Electronic address: m.m.fockens@amc.nl.
authors.forename: M Matthijs
authors.initials: MM
authors.lastname: Fockens
authors.affiliation: Department of Radiology, The Netherlands. Electronic address: r.vanrijn@amc.nl.
authors.forename: Rick R
authors.initials: RR
authors.lastname: van Rijn
authors.affiliation: Department of Radiology, The Netherlands. Electronic address: m.maas@amc.nl.
authors.forename: Mario
authors.initials: M
authors.lastname: Maas
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands. Electronic address: j.c.goslings@amc.nl.
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
authors.affiliation: Department of Surgery, Paediatric Surgical Centre Amsterdam, The Netherlands. Electronic address: r.bakx@amc.nl.
authors.forename: Roel
authors.initials: R
authors.lastname: Bakx
authors.affiliation: Department of Radiology, The Netherlands. Electronic address: g.j.streekstra@amc.nl.
authors.forename: Geert J
authors.initials: GJ
authors.lastname: Streekstra
authors.affiliation: Department of Radiology, The Netherlands. Electronic address: l.f.beenen@amc.nl.
authors.forename: Ludo F M
authors.initials: LFM
authors.lastname: Beenen
authors.affiliation: Trauma Unit, Department of Surgery, Maasstadziekenhuis, Rotterdam, The Netherlands. Electronic address: schepn@maasstadziekenhuis.nl.
authors.forename: Niels W L
authors.initials: NWL
authors.lastname: Schep
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011829:Radiation Dosage; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000453:epidemiology
keywords: Canadian C-spine rule; Cervical spine clearance; Children; NEXUS criteria; Radiographic imaging