Intended for healthcare professionals

Rapid response to:

Practice ABC of Emergency Radiology, 3rd Edition

Cervical Spine

BMJ 2014; 348 doi: (Published 21 August 2014) Cite this as: BMJ 2014;348:bmj.g2177

Rapid Response:

Although traumatic spinal cord injuries in children are rare the consequences can be devastating. The annual incidence of traumatic spinal cord injury in the United Kingdom is unknown, but based on statistics collated from the United States is estimated to be 40 per million population with children under 12 accounting for less than 1%(1). Due to their relatively large head and increased laxity in spinal structures, children have different mechanisms of injury to adults with potentially catastrophic physiological effects on cardiorespiratory function. The first 24 hours is associated with the highest morbidity and mortality(2) and the infrequent presentation of injured children increases the risk of poor outcome due to occasional practice. The avoidance of complications requires an early, high level of input from a dedicated multi-disciplinary spinal team.

With the introduction of trauma networks in 2010 it became critical for the development of joint protocols for the management of traumatic spinal cord injury between each Major Trauma Network and affiliated Spinal Cord Injury Centre, mandated by the NHS Clinical Advisory Groups Report in 2011(3).

We collaborated with the London Spinal Cord Injury Centre in Stanmore to produce a guideline for the management of children with traumatic spinal cord injuries. The guideline was nationally endorsed in June 2014 by the Spinal Cord Injury Clinical Research Group, part of Specialised Commissioning NHS England. A link to our pathway can be found on the College of Emergency Medicine website at with a link to the national advice document at

We encourage other trauma networks and spinal cord injury centres throughout the United Kingdom to produce similar locally agreed documents to decrease complications and optimise outcomes of children with traumatic spinal cord injuries.

1. National Spinal Cord Injury Statistical Centre, University of Alabama at Birmingham, 2013 Annual Statistical Report – Complete public version [cited 2014 Sep 16]. Available at:
2. Jones L. and Bagnall AM. Spinal injuries centres (SICs) for acute traumatic spinal cord injury. Cochrane Database of Systematic Reviews 2004, Issue 4. Art No.: CD004442. DOI: 10.1002/14651858.CD004442.pub2.
3. Regional Trauma Networks. NHS Clinical Advisory Group on Major Trauma Workforce. Centre for Workforce Intelligence, 2011 [cited 2014 Sep 16]. Available at:

Competing interests: No competing interests

17 September 2014
Danielle S Hall
Specialist Trainee in Paediatric Emergency Medicine
Sakura Hingley
St Thomas' Hospital, London