Once a child is determined to be at risk of having a cervical spine injury, clinicians must take appropriate precautions to avoid potential worsening of neurologic deficits. Occasionally these decisions are made in the absence of adequate cervical spine imaging when dealing with a child’s unstable airway or other life-threatening injuries. Furthermore, clinicians have to make decisions regarding appropriate diagnostic testing to evaluate for potential injury. Decisions regarding testing should take into consideration the clinical presentation of the patient, aiming to order appropriate testing for those at risk and avoid unnecessary testing for those without signs of cervical spine injury.
Key points
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Cervical spine injury is rare, especially in children younger than 8 years.
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Motor vehicle crashes are the most common cause of blunt cervical spine injury in children, although sports-related injuries and falls are also important.
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Violence, including penetrating trauma, is the third leading cause of spinal cord injury in children.
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Altered mental status, focal neurologic deficit, neck pain, torticollis, substantial torso trauma, high-risk motor vehicle crash, diving, and predisposing conditions are factors associated with blunt cervical spine injury in children, and can be used to develop screening guidelines.
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Manual in-line cervical stabilization should be used during intubation of the victim of blunt trauma.
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A rigid collar is an adequate precaution for the cervical spine following blunt trauma.
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The rigid long board should be used as an out-of-hospital extrication and transfer device for those children who are significantly injured. Use of the rigid long board should be discontinued as soon as possible because of its associated risks.
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Three-view plain cervical radiographs are good for screening children who have normal mental status and no focal neurologic findings.
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Children younger than 8 years are more likely to injure their upper cervical spine.
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There is a wide variety of cervical spine injury patterns; the most common injury is atlanto-axial rotary subluxation.
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Spinal cord injury without radiographic association is also common, but may be overreported.
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Mortality in children who sustain cervical spine injury is high.
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