Children can be clinically cleared without C-spine imaging if they have GCS 14-15, are not intoxicated, have no painful distracting injury, no neurologic deficits, no midline cervical tenderness, and can move head in all directions without limitation
Children age 3 and under can be clinically cleared unless they have high-risk mechanism of injury, particularly child abuse where C-spine injury rates are very high
Meta-analysis of 5 adult studies with 1,000 patients showed that with completely normal CT scans (no osteophytes, no degenerative disease), 9% had stable injuries on MRI requiring no treatment, and no patient required surgery
Cervical collar pressure ulcers occur in 6-38% of patients, typically on clavicles, back of head, and base of neck; occur in ICU patients who receive significant fluid and have ICP monitors or are ventilated
quoteShow of hands, who thinks they over-image C-spines and trauma? Most of the room, right? And we're talking to a group of pediatric surgeons. So we are the experts in pediatric trauma, and we self-admittedly over-image.↗
▶Ep 2 · 6:20
guidelineChildren can be clinically cleared without C-spine imaging if they have GCS 14-15, are not intoxicated, have no painful distracting injury, no neurologic deficits, no midline cervical tenderness, and can move head in all directions without limitation↗
▶Ep 2 · 7:05
guidelineChildren age 3 and under can be clinically cleared unless they have high-risk mechanism of injury, particularly child abuse where C-spine injury rates are very high↗
▶Ep 2 · 9:35
quoteI think of all the things I'm talking about today, this is the one problem that we as pediatric surgeons need to address. We need to take ownership of this problem, we need to take ownership of the over-imaging, over radiation of trauma patients at non-pediatric centers.↗
▶Ep 2 · 10:20
clinicalBoston study of 300 children with normal initial C-spine imaging showed only 2% had ligamentous injury on MRI, none required surgery, and 84% were clinically cleared at first clinic visit 1-2 weeks later↗
▶Ep 2 · 12:10
clinicalCervical collar pressure ulcers occur in 6-38% of patients, typically on clavicles, back of head, and base of neck; occur in ICU patients who receive significant fluid and have ICP monitors or are ventilated↗
▶Ep 2 · 13:20
clinicalMeta-analysis of 5 adult studies with 1,000 patients showed that with completely normal CT scans (no osteophytes, no degenerative disease), 9% had stable injuries on MRI requiring no treatment, and no patient required surgery↗
▶Ep 2 · 14:15
opinionAdult recommendation is to remove collar with normal CT scan without MRI, but this has not been validated in children who have greater frequency of unstable ligamentous injury↗
▶Ep 2 · 15:00
quoteWe have a huge opportunity to decrease radiation sedation resource utilization in these patients. I think that there are reasonable guidelines that exist, but we really need to improve these, and the only way to improve these is for us to be at the table, generating data, strengthening these guidelines, and really reaching out to the adult centers so that we can provide our expertise for them.↗
▶Ep 2 · 21:50
quoteI think we all come to work every day trying to do the best thing for our patients and we're trying to do the best thing for our patients. But when it comes to certain injuries, people often practice defensive medicine and they order more studies that are indicated.↗
Aaron's statements about Cervical Spine Injury10 statements
quoteShow of hands, who thinks they over-image C-spines and trauma? Most of the room, right? And we're talking to a group of pediatric surgeons. So we are the experts in pediatric trauma, and we self-admittedly over-image.↗
▶Ep 3 · 6:20
guidelineChildren can be clinically cleared without C-spine imaging if they have GCS 14-15, are not intoxicated, have no painful distracting injury, no neurologic deficits, no midline cervical tenderness, and can move head in all directions without limitation↗
▶Ep 3 · 7:05
guidelineChildren age 3 and under can be clinically cleared unless they have high-risk mechanism of injury, particularly child abuse where C-spine injury rates are very high↗
▶Ep 3 · 9:35
quoteI think of all the things I'm talking about today, this is the one problem that we as pediatric surgeons need to address. We need to take ownership of this problem, we need to take ownership of the over-imaging, over radiation of trauma patients at non-pediatric centers.↗
▶Ep 3 · 10:20
clinicalBoston study of 300 children with normal initial C-spine imaging showed only 2% had ligamentous injury on MRI, none required surgery, and 84% were clinically cleared at first clinic visit 1-2 weeks later↗
▶Ep 3 · 12:10
clinicalCervical collar pressure ulcers occur in 6-38% of patients, typically on clavicles, back of head, and base of neck; occur in ICU patients who receive significant fluid and have ICP monitors or are ventilated↗
▶Ep 3 · 13:20
clinicalMeta-analysis of 5 adult studies with 1,000 patients showed that with completely normal CT scans (no osteophytes, no degenerative disease), 9% had stable injuries on MRI requiring no treatment, and no patient required surgery↗
▶Ep 3 · 14:15
opinionAdult recommendation is to remove collar with normal CT scan without MRI, but this has not been validated in children who have greater frequency of unstable ligamentous injury↗
▶Ep 3 · 15:00
quoteWe have a huge opportunity to decrease radiation sedation resource utilization in these patients. I think that there are reasonable guidelines that exist, but we really need to improve these, and the only way to improve these is for us to be at the table, generating data, strengthening these guidelines, and really reaching out to the adult centers so that we can provide our expertise for them.↗
▶Ep 3 · 21:50
quoteI think we all come to work every day trying to do the best thing for our patients and we're trying to do the best thing for our patients. But when it comes to certain injuries, people often practice defensive medicine and they order more studies that are indicated.↗
