Cervical Spinal Injury In Pediatric Blunt Trauma Patients: Management In The Emergency Department (Trauma CME) - $39.00
Publication Date: March 2016 (Volume13, Number 3)
CME: This issue includes 4 AMA PRA Category 1 CreditsTM; 4 ACEP Category 1 credits, 4 AAP Prescribed credits, and 4 AOA Category 2A or 2B CME credits.
Spinal injuries from blunt trauma are uncommon in pediatric patients, representing only about 1.5% of all blunt trauma patients. However, the potentially fatal consequences of spinal injuries make them of great concern to emergency clinicians. Clinical goals in the emergency department are to identify all injuries using selective imaging and to minimize further harm from spinal cord injury. Achieving these goals requires an understanding of the age-related physiologic differences that affect patterns of injury and radiologic interpretation in children, as well as an appreciation of high-risk clinical clues and mechanisms. This issue reviews current approaches to prehospital immobilization, identification of low-risk patients who may be clinically cleared from immobilization, a rational approach to the use of radiologic imaging, and the existing evidence for medical management of spinal cord injuries.
Excerpt From This Issue
A 3-year-old girl presents to the ED after a highway motor vehicle crash. The car she was riding in was traveling at 70 mph when it struck another car that was turning onto the highway. The child was in an appropriate child-restraint seat in the rear passenger seat. The driver was declared dead on the scene and the front passenger was severely injured. The child was boarded and collared on scene, and was hemodynamically stable during transport. A primary survey reveals no concerning physical findings. On secondary survey, she has midline tenderness at C2. There are no neurologic deficits, and she has a GCS score of 15. You are concerned about a spinal injury, but how do you proceed to investigate and manage this patient? Does the history of the incident make a spinal cord injury more or less likely? How likely is a cervical spine injury in a young child? Are there normal differences in the radiologic findings for young children? Do you have to perform imaging to clear a cervical spine, or is a clinical examination sufficient at this age? If you image, what do you choose, plain x-ray, CT, or MRI?