title: Heterogeneity in cervical spine assessment in paediatric trauma: A survey of physicians' knowledge and application at a paediatric major trauma centre.
abstract: OBJECTIVE
  Evidence-based decision-making tools are widely used to guide cervical spine assessment in adult trauma patients. Similar tools validated for use in injured children are lacking. A paediatric-specific approach is appropriate given important differences in cervical spine anatomy, mechanism of spinal injury and concerns over ionising radiation in children. The present study aims to survey physicians' knowledge and application of cervical spine assessment in injured children.
  
  
  METHODS
  A cross-sectional survey of physicians actively engaged in trauma care within a paediatric trauma centre was undertaken. Participation was voluntary and responses de-idenitified. The survey comprised 20 questions regarding initial assessment, imaging, immobilisation and perioperative management. Physicians' responses were compared with available current evidence.
  
  
  RESULTS
  Sixty-seven physicians (28% registrars, 17% fellows and 55.2% consultants) participated. Physicians rated altered mental state, intoxication and distracting injury as the most important contraindications to cervical spine clearance in children. Fifty-four per cent considered adequate plain imaging to be 3-view cervical spine radiographs (anterior-posterior, lateral and odontoid), whereas 30% considered CT the most sensitive modality for detecting unstable cervical spine injuries. Physicians' responses reflected marked heterogeneity regarding semi-rigid cervical collars and what constitutes cervical spine 'clearance'. Greater consensus existed for perioperative precautions in this setting.
  
  
  CONCLUSIONS
  Physicians actively engaged in paediatric trauma care demonstrate marked heterogeneity in their knowledge and application of cervical spine assessment. This is compounded by a lack of paediatric-specific evidence and definitions, involvement of multiple specialties and staff turnover within busy departments. A validated decision-making tool for cervical spine assessment will represent an important advance in paediatric trauma.
authors.affiliation: Department of Orthopaedics, The Royal Children's Hospital, Melbourne, Victoria, Australia.|NYU Langone Medical Center - Hospital for Joint Diseases, New York, New York, USA.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Buckland
authors.affiliation: Trauma Service, The Royal Children's Hospital, Melbourne, Victoria, Australia.|Emergency Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.|Department of Woman's and Child's Health, University of Padova, Padova, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bressan
authors.affiliation: Trauma Service, The Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Jowett
authors.affiliation: Department of Orthopaedics, The Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Johnson
authors.affiliation: Trauma Service, The Royal Children's Hospital, Melbourne, Victoria, Australia. warwick.teague@rch.org.au.|Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia. warwick.teague@rch.org.au.|Surgical Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia. warwick.teague@rch.org.au.
authors.forename: Warwick J
authors.identifier: http://orcid.org/0000-0003-4747-6025
authors.initials: WJ
authors.lastname: Teague
mesh_terms: D002574:Cervical Vertebrae / Q000293:injuries*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013124:Spinal Injuries / Q000175:diagnosis* / Q000628:therapy; D011795:Surveys and Questionnaires; D014193:Trauma Centers; D014739:Victoria
keywords: cervical spinal clearance; child; decision-making; healthcare surveys; spine injury