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Using cervical spine clearance guidelines in a pediatric population: a survey of physician practices and opinions

Published online by Cambridge University Press:  11 May 2015

Emma C. Burns  and
Natalie L. Yanchar
Emma C. Burns*
Affiliation:
Department of Pediatrics, IWK Health Centre, Halifax, NS
Natalie L. Yanchar
Affiliation:
Department of Pediatrics, IWK Health Centre, Halifax, NS
*
Department of Pediatric Emergency Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8C1; ecmburns@yahoo.ca.

Abstract

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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.

Keywords

Canadian C-Spine Rule studyCervical-SpineguidelinesNEXUSpediatric traumapractice variation
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 1 , January 2011 , pp. 1 - 6
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

References

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