The jts cervical spine clearance status sheet or trauma resuscitation record dd form 3019 should be used to document the cervical spine. Trauma practice management guidelines as the accrediting body for trauma centers in pennsylvania, the pennsylvania trauma systems foundation was created in 1985 to assure optimal care of injured patients throughout the. Before cervical spine precautions can be safely removed, the cervical spine must be effectively excluded from injury, or cleared. Prehospital cervical spinal immobilization after trauma in. Multidetector ct of blunt cervical spine trauma in adults. Acute cervical spine trauma symptoms, diagnosis and. Before cervical spine precautions can be safely removed, the cervical spine must be effectively.
Cervical spine injuries in patients older than 65 years 15. The overall prevalence of traumatic cervical spine injury csi in trauma is. The canadian cspine rule for alert and stable trauma patients where cervical spine injury is a. Application of the current rmh cervical spine guideline resulted in a. Cervical mr imaging has demonstrated a utility for detecting soft tissue injury in nonaccidental trauma. Altered mental status, focal neurologic deficit, neck pain. Staff should be mindful of possible occipital skin breakdown from the cervical collar.
Common mechanisms of injury include motor vehicle accidents, falls, pedestrians vs vehicles and diving accidents. Trauma practice management guidelines as the accrediting body for trauma centers in pennsylvania, the pennsylvania trauma systems foundation was created in 1985 to assure. An international team of authors deals in detail with the history of the spinal surgery. Early c spine immobilisation is required if there is any suspicion of potential injury. As per the atls and spinal cord trauma guidelines, good quality radiographs of the cervical spine anteroposterior, lateral, and odontoid view, if accurately interpreted along with axial ct of. Topics clinical assessment imaging injuries management quiz 3. Awake patient gcs15 without cervical tenderness and no distracting injury. Clinical decision rules and figures 2, 3, and 4 initial evaluation and. Results from a multicenter, prospective, observational american association for the surgery of trauma study. Magnetic resonance imaging mri has been playing an increasingly important role in the spinal trauma patients due to high sensitivity for detection of acute soft tissue and cord. The misdiagnosis of acute cervical spine injuries and fractures in infants and children. Cervical spine evaluation and clearance in the intoxicated.
Assessment following trauma article pdf available in australian family physician 414. Acute cervical spine trauma encompasses a wide range of potential injuries to ligaments, muscles, bones, and spinal cord that follow acute incidents ranging from a seemingly. Does this patient with cervical spine trauma need any imaging. Acute cervical spine trauma guidelines bmj best practice. Practice management guidelines for identification of cervical spine injuries following trauma. The purpose of our study is to identify risk factors associated with cervical spine injury in children after blunt trauma. Cervical spine trauma is a common problem with a wide range of severity from minor ligamentous injury to frank osteoligamentous instability with spinal cord injury. Spine and spinal cord injuries san francisco general. Because of the serious medical, psychological and financial consequences of missed fractures, the use of imaging of the cervical spine to exclude fracture is a routine part of the evaluation of the. Mr imaging of the cervical spine in nonaccidental trauma.
After blunt trauma, the cervical spine should be considered injured until proven otherwise. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blun t trauma. Cervical spine trauma kids health wa pmh ed guidelines. Spine trauma approach to the patient and diagnostic evaluation harman singh, md. Patients may present immediately after a traumatic incident or days to weeks later. These patients are excluded from this guideline and should receive immediate neurosurgical. If a spinal cord injury is present, damage is termed primary or secondary. Staff should be mindful of possible occipital skin breakdown from the cervical.
While injury to the cervical spine is common after trauma such as motor vehicle accidents and falls, fractures of the cervical spine are uncommon. A prospective, multicenter study of the research consortium of new england centers for trauma reconect beta blockers in critically ill patients with traumatic brain injury. Trauma clinical guideline cervical spine injury evaluation. Emergency physicians triage patients with suspected cervical spine injury into high and lowrisk groupsthat is, those who require imaging for confirmation and. The monograph is divided into 16 chapters focused on individual issues of injuries to the cervical spine.
Patients with obvious neurological deficit due to cervical spine injury. It has been reported that the cervical spine is injured in 2. Understanding the epidemiology, anatomy, biomechanics, and classification of subaxial cervical spine injuries is. The discs in the spine that separate and cushion vertebrae. Younger children have a relatively higher fulcrum with a larger head, predisposing to occipital cervical injures. Cervical spine trauma is a common problem with a wide range of severity from minor ligamentous injury to frank osteoligamentous instability with spinal cord. Cervical and thoracolumbar spine injury evaluation, transport. Symptomatic trauma patients options if an awake patient has neck pain or tenderness and normal cspine xray including ct as needed, discontinue ccollar after normal flexex films. National emergency x radiography utilization study group. Risk factors for cervical spine injury have been developed to safely limit immobilization and. Application of the current rmh cervical spine guideline resulted in a 99. Violence, including penetrating trauma, is the third leading cause of spinal cord injury in children. In this article, clearance refers to the confident exclusion of unstable cervical spine injuries that.
Complete spinal cord injury, with loss of motor and sensory function below. The workgroup meets regularly to encourage communication among services and to share best practices. Pearls and pitfalls accurate diagnosis of acute cervical spine injury requires cooperation between clinician and radiologist, a reliable and repeatable approach to interpreting cervical. To provide guidance for determining if a trauma patient has a cervical injury. Early cspine immobilisation is required if there is any. March 2015 background injury to the cervical spine is a common occurrence in the polytrauma. At some events, cell phones may not be effective due to the size of. Normal thickness and appearance of the prevertebral soft. These critical situations depend on sports medicine personnel understanding every aspect of sideline care to ensure a safe and successful evaluation.
Facial trauma such as fractures, tooth loss or severe lacerations. In urban trauma centers, helical ct as the initial screening test in the evaluation for cervical spine fractures has been shown to lower both complications and institutional costs. Immobilization in a cervical collar is not necessary unless the trajectory suggest direct injury to the cervical spine. The anatomy of the developing cervical spine predisposes children to injury of the. Subaxial cervical spine injuries are common, ranging in severity from minor ligamentous strain or spinous process fracture to complete fracturedislocation with bone and ligament failure, resulting in severe spinal cord injury. Pearls and pitfalls accurate diagnosis of acute cervical spine injury requires cooperation between clinician and radiologist, a reliable and repeatable approach to interpreting cervical spine ct, and the awareness that a patient may have a significant and unstable ligamentous injury despite normal findings.
Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening. Cervical spine trauma page 2 of 10 many now advocate ct for all trauma cases in which the cspine needs to be evaluated. Cervical and thoracolumbar spine injury evaluation. Cervical spine injuries in children and adolescents 14. Prehospital cervical spinal immobilization after trauma. Subaxial cervical spine injury classification slic injury morphology points compression burst 1 1 distraction 3 translation rotation 4 total max 4 dlc status points intact 0 intermediate 1 disrupted 2 total max 2 neuro status points intact 0 nerve root deficit 1 complete cord injury 2 incomplete cord injury 3 addon. The purpose of this study was to identify the incidence and types of cervical spine injury on mr imaging in nonaccidental trauma and to correlate cervical spine injury with parenchymal injury on brain mr imaging and findings on head ct. Younger children have a relatively higher fulcrum with a larger. All patients with history of trauma should have their cervical spine c spine evaluated clinically or radiographically. Neurologic deficits in torso, legs or arms not explained by peripheral nerve injuries. Cervical spine clearance in trauma patients mcgovern. Cervical and thoracolumbar spine injury surgical management and transport cpg id. While cervical spine injury is more common in patients with multiple injuries, isolated injury may occur following comparatively minor traumatic incidents.
Ed trauma cervical spine stabilization and evaluation. Role of magnetic resonance imaging in acute spinal trauma. Trauma clinical guideline cervical spine injury evaluation the trauma medical directors and program managers workgroup is an open forum for designated trauma services in washington state to share ideas and concerns about providing trauma care. Nevertheless, fear of missing cervical spine injuries, with their potential to produce severe neurologic disability, has led to the use of radiographic spine imaging in virtually all patients. Age, injury, poor posture or diseases such as arthritis can lead to degeneration of the bones or joints of the cervical spine, causing disc herniation or bone spurs to form. Factors associated with cervical spine injury in children. Cervical spine trauma is one of the most common sites of spinal cord injury sci. Assume a spine injury until proven otherwise in blunt trauma xray the entire axial skeleton if. Trauma clinical guideline cervical spine injury evaluation the trauma medical directors and program managers workgroup is an open forum for designated trauma services in washington.
Approximately 72% of spinal injuries in children under 8 years old occur in the cervical spine 3. Cervical spine clearance upstate medical university. Communication is an essential component for successful cervical spine trauma evaluation and initiation of management. Cervical stenosis occurs when the spinal canal narrows and compresses the spinal cord and is most frequently caused by aging. Cervical spine injuries account for about 50% of spinal injuries 2. Subaxialcervical spine trauma pooriasalari, md assistant professor of orthopaedics department of orthopaedic surgery st. Such patients often have suspected cervical spine injury necessitating cervical spine radiographs. Cervical spine injury pediatric clinics of north america. Cervical spine injury csi is uncommon in children, accounting for only 12% of pediatric trauma. Upper cervical spine trauma orthopaedic trauma association. Cervical spine injuries are less common in children than in adults, with 1%2% of pediatric trauma victims requiring hospitalization 7. Risk factors for cervical spine injury have been developed to safely limit immobilization and radiography in adults, but not in children. Staff should maintain cervical spine immobilization until arrival at definitive care while transiting ae system. Complete spinal cord injury, with loss of motor and sensory function below the level of injury, is often irreversible and leads to devastating consequences.
Background intoxication often prevents clinical clearance of the cervical spine csp after trauma leading to prolonged immobilization even with a normal computed tomography ct. Sudden severe injury to the neck may also contribute to disc herniation, whiplash, blood vessel destruction, vertebral bone or ligament injury and, in extreme cases. Cspine trauma juliana tsuruta radiology fellow 12052016 2. The importance of detecting cervical spine injury is obvious because failure to do so can lead to tragic consequences for patient and physician alike. Acute cervical spine trauma encompasses a wide range of potential injuries to ligaments, muscles, bones, and spinal cord that follow acute incidents ranging from a seemingly innocuous fall to a highenergy motor vehicle accident. Clearance of cervical spine injury in conscious, symptomatic patients z1. Cervical spine trauma background all children with serious trauma should be treated as though they have a cervical spine injury. Radiology of the cervical spine in trauma patients. A patient with possible c spine injury as defined in section 1 above usually based on mechanism may have their cervical spine cleared without further radiologic evaluation if all of the following conditions exist. Radiological evaluation of the cervical spine is indicated for all patients who do not meet the criteria for clinical clearance as described above z2. The prevalence of upper cervical injury relates to physiologic differences in the pedi atric cervical spine. Unfused synchondroses, especially at the level of the dens, are susceptible to trauma. Spine and spinal cord injuries ucsf zuckerberg san.
Upper cervical spine occult injury and trigger for ct exam. Management of cervical spine trauma in children 779 1 3 more common 75% incomplete versus 25% complete 1. Imaging studies should be technically adequate and interpreted by experienced clinicians. Cervical spine clearance guideline page 1 of 2 pages last revised. Trauma constitutes a significant portion of emergency department practice. Cervical spine trauma is a relatively rare but catastrophic event in sports. Cervical spine evaluation and clearance in the intoxicated p. Anatomically, subaxial cervical spine trauma consists of injuries from c3 to c7, 1 2. Selective cervical spine radiography in blunt trauma. The canadian cspine rule for alert and stable trauma patients where cervical spine injury is a concern. We help you diagnose your subaxial cervical trauma case and provide detailed descriptions of how to manage this and hundreds of other pathologies. Nevertheless, fear of missing cervical spine injuries, with their potential to produce severe neurologic disability, has led to the use of radiographic spine imaging in virtually all patients with blunt trauma.