Clinical Review Lesson of the week

Immobilisation of the cervical spine in children

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7337.591 (Published 09 March 2002) Cite this as: BMJ 2002;324:591
  1. Sophie Skellett (sophie7@doctors.org.uk), fellow,
  2. Shane M Tibby, consultant,
  3. Andrew Durward, consultant,
  4. Ian A Murdoch, director
  1. Department of Paediatric Intensive Care, Guy's Hospital, London SE1 9RT
  1. Correspondence to: S Skellett
  • Accepted 29 August 2001

Recognition and early management of children at risk of injury to the cervical spinal cord is lacking

Trauma to the cervical spine accounts for 1.5% of admissions in children with trauma in the United States, 35% of which have an associated injury of the cervical spinal cord.1 Such an injury may occur along with bony or ligamentous damage. Ligamentous damage encompasses injury to the spinal cord without radiological evidence of abnormalities.2 Immobilisation of the cervical spine is mandatory in patients at risk to prevent the development of injury to the cervical spinal cord and its progression.24

Most children requiring hospital admission for trauma are considered at risk of injury of the cervical spinal cord. The commonest causes are road crashes, falls from greater than 4.6 metres, head injuries, and injuries elsewhere to the spine. 5 6 These patients require immobilisation of the spine, commonly achieved with a rigid collar and a supplemental device. Immobilisation should be discontinued only after exclusion of bony and ligamentous damage, which needs an adequate clinical examination.7 Important features of the examination are neck pain, midline tenderness on palpation of the neck, and any signs or symptoms of neurological injury.8 This is possible only in a conscious patient (Glasgow coma score >13) who does not have painful distracting injuries. The negative predictive value of clinical examination is almost 100%.8 Radiological evaluation plays a part, initially in identifying unstable fractures requiring urgent surgery.

As the lead centre for paediatric intensive care in the south east of England, Guy's Hospital provides a retrieval service for three paediatric intensive care units, collecting patients from over 30 district general hospitals. We were thus able to audit immobilisation of the cervical spine in children who were at risk of injury to the cervical …

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