Traumatic pediatric cervical spine injury—a proposed clearance algorithm incorporating a 24-h time delay

• Published in: Child's nervous system 2025-12, Vol.41 (1), p.58, Article 58
• Main Authors: Fischer, Victoria E., Mahadev, Vaidehi M., Bethel, Jacob A., Quirarte, Jaime A., Hammack, Robert J., Gragnaniello, Cristian, Tarasiewicz, Izabela
• Format: Article
• Language: English
• Subjects: Adolescent; Algorithms; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - injuries; Child; Child, Preschool; Clinical Decision Rules; Female; Humans; Infant; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Neurosciences; Neurosurgery; Retrospective Studies; Spinal Injuries - diagnostic imaging; Time Factors; Tomography, X-Ray Computed - methods
• ISSN: 0256-7040; 1433-0350; 1433-0350
• DOI: 10.1007/s00381-024-06716-x

Purpose Pediatric cervical spine injury (pCSI) is rare. Physiological differences necessitate alternate management from adults. Yet, no standardized pediatric protocols exist. Previous investigations applying adult-validated clinical decision rules (CDRs)—NEXUS Criteria (NX) and Canadian C-spine Rules (CCR)—to children are mixed. We hypothesized a combined NX + CCR approach applied at a delayed 24-h time point would enhance screening efficacy in select patients. Methods We conducted a retrospective review of a prospectively-collected database over 15 months at a pediatric-capable Level-1 trauma center. Age and mechanism determined initial inclusion. NX and CCR criteria were collected and retroactively applied on arrival (T0) and 24 h later (T1). Statistical analyses were performed in SPSS. Results A total of 306 patients met inclusion. Current practices compel computed tomography (CT) overuse for craniocervical evaluations: 298 (97.4%) underwent ≥ 1 CT. Of cervical spines imaged ( n  = 175), 161 (92.0%) underwent CT while 74 (42.3%) underwent magnetic resonance imaging with 14 (18.9%) completed after 72 h. Of collars placed on arrival ( n  = 181), 136 (75.1%) were cleared before discharge with 86 (63.2%) CTs denoting preferred clearance modality; CT utilization was unchanged when stratified by age