Pediatric emergency medicine trisk 1057 1057
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serious underlying pathology such an oncologic diagnosis. It is also important to
assess for associated signs and symptoms. Fever may be a sign of an infectious,
neoplastic, or rheumatologic etiology of pain. Associated numbness, weakness, or
incontinence is especially concerning for spinal cord involvement.
Physical examination. In the setting of acute trauma, exclusion of an unstable
spinal injury is of paramount concern and supersedes a comprehensive detailed
physical examination. If signs or symptoms suggest neurologic deficits after
trauma, the patient should remain immobilized and timely spine specialist
consultation (either neurosurgical or orthopedic) should be sought. In the absence
of trauma, ascertainment of spinal cord involvement is of utmost importance.
Weakness, sensory loss, abnormal deep tendon reflexes, saddle anesthesia, and
loss of rectal tone suggest spinal cord involvement and potentiate the need for
emergent imaging.
