239. Optimizing Care for Pediatric Cervical Spine Injury

Authors: Jacob Alexander Bethel; Dylan De Muth; Victoria Fischer; Derek Samples; Izabela Tarasiewicz, MD (San Antonio, TX)

Introduction:
Traumatic cervical spine injury in pediatric patients is rare, and variations from adult patients in regard to anatomy, clinical exam, and effects of radiation lead to management challenges. Thus, children may require different screening and diagnostic methods. Standardization, however, is lacking, leading to prolonged cervical collar use, excessive radiation, incorrect diagnoses, and delayed use of MRIs. Therefore, we sought to create a validated pediatric cervical spine protocol for the initial assessment, diagnosis, and management considerations of cervical spine injury. We also assessed which factors portend an increased risk for cervical spine injury warranting surgical intervention.

Methods:
A retrospective review of a prospectively collected database of pediatric trauma patients at a level 1 trauma center was analyzed over ten years. Patients with concern for cervical spine injury on arrival based on mechanism, placement of a cervical collar, neurological deficits, or cervical spine specific imaging obtained were evaluated. This, in conjunction with literature, was used to create an updated safe diagnostic management protocol.

Results:
A total of 114 patients were identified, two-thirds (66.7%) endured high-impact injuries. One half of those received an MRI (48.7%), which illustrated ligamentous injury in more than half (56.7%). Additionally, greater than 1 in 8 children (13.5%) with high impact injury received an MRI after 48 hours post-injury compared to 1 in 7 (14.8%) with both high and low impact injuries. Furthermore, many patients received unnecessary radiation from CT scans, while others remained in cervical collars for unnecessary prolonged time periods.

Conclusion:
Our new proposed protocol minimizes the time delays in both cervical collar clearance and obtaining the proper imaging, while also aiming to avoid unnecessary radiation exposures from CTs in the young patient population, which allows the trauma team to clinically clear non-injured patients while also advancing toward the proper diagnostic strategy in a timely manner.