Implementation of a pediatric trauma cervical spine clearance pathway. ACS Quality and Safety Case Studies

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Bulletin of the American College of Surgeons


Pediatric cervical spine (c-spine) injuries are rare events, with an incidence of approximately 1 to 2 percent and potentially devastating consequences. Although the incidence, characteristics, and severity of c-spine injuries differ between adult and pediatric populations, pediatric patients are generally subjected to the same traumatic workup of their c-spine as adult trauma patients. Until recently, the c-spine workup at many institutions involved obtaining multiple c-spine films and often a complete c-spine computed tomography (CT) scan. Aggressive imaging in the pediatric patient population can be costly and may expose children to large amounts of radiation and, therefore, potential future malignancies. Injuries cannot be missed, but patients at low risk for injury should not be subject to unnecessary radiation exposure early in their lives. An established algorithm for c-spine evaluation can help balance these conflicting ideals in clinical decision making. Separate pathways for clearance of the pediatric c-spine have been found to be effective and reduce radiation exposure.