Challenges and Progress in Identifying Cervical Spine Injuries in Children.

Abstract

* Abbreviations: CSI — : cervical spine injury NEXUS — : National Emergency X-Ray Utilization Study Over 8 million children are treated in the emergency department for traumatic injuries annually, many of whom undergo cervical spine evaluation.1 However, clinically significant cervical spine injury (CSI) is rare in children, occurring in only 1% to 2% of children undergoing cervical spine radiography after blunt trauma.2 Although most children with CSI have readily apparent signs or symptoms of injury, the risks of missing CSI can be grave, leaving clinicians with a quandary as to how to evaluate the unlikely possibility of CSI in the vast majority of injured children. Despite the infrequency of CSI among children without suggestive symptoms or signs, many clinicians have a low threshold for obtaining imaging studies to avoid the potentially serious and costly consequences of missing a CSI. However, the liberal use of imaging must be balanced against considerations of use, radiation exposure, and cost. Unfortunately, limited data exist to inform clinical decision-making regarding the need for diagnostic imaging for the evaluation of CSI in children. Most of the literature in this area has been retrospective in nature, and the … Address correspondence to Mark I. Neuman, MD, MPH, Division of Emergency Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail: mark.neuman{at}childrens.harvard.edu