Cervical Spine Clearance in the Pediatric Trauma Patient

Purpose of review: In this review, we examine the current evidence-based practices in cervical spine evaluation and imaging in injured children, with an emphasis on criteria for cervical collar removal. The primary goal of this review is to synthesize an algorithm for cervical spine clearance using the best available evidence. Recent findings: Removal of the cervical collar without imaging is appropriate for most asymptomatic patients that are conscious and neurologically intact. Patients with negative imaging and persistent neck pain can be safely discharged home in a cervical collar with outpatient follow-up. High-resolution computed tomography (CT) of the cervical spine is superior to plain films in ruling out cervical spine injury and approaches the sensitivity of magnetic resonance imaging (MRI). Suspected or confirmed victims of nonaccidental trauma should undergo MRI of the cervical spine, as it may aid in confirming the mechanism of injury and identify non-bony injuries that would otherwise go unnoticed. Summary: Most pediatric trauma patients do not require advanced imaging (CT or MRI) to clear the cervical spine. A period of observation and cervical collar stabilization is appropriate for most patients without overt evidence of severe cervical spine trauma. Interval re-examination may be performed, as many patients will have resolution of pain and can then be cleared clinically without advanced cross-sectional imaging. When advanced imaging is sought, spine specialist consultation is recommended. © 2019, Springer Nature Switzerland AG.