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?
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