Pediatric emergency medicine trisk 3580 3580
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FIGURE 112.10 Cervical spine immobilization should not place the patient at an increased risk
for morbidity. Securing straps should be placed around bony prominences and strap location
reassessed after any movement of the patient. A neutral position of the neck should be ensured,
and if necessary (younger child), a spacer can be placed underneath the child’s torso and lower
extremities to achieve the desired position.
There is no standard or definitive evidence to support the practice of clinically
clearing the pediatric cervical spine in the prehospital environment. Therefore, it
is not recommended that prehospital providers clear a child’s cervical spine if the
child has experienced a potentially significant mechanism of injury. In one large
study, prehospital spine immobilization for children <2 years was applied
inconsistently including 25% of this age group with documented cervical spine
injuries. A perceived lack of options for immobilization was cited as a reason for
this practice variation. A 2017 study found moderate agreement between
prehospital providers and ED physicians in assessing pediatric patients presenting
with blunt trauma for cervical spine injury risk factors but did not show moderate
agreement of cervical spine injury prediction. More research may help us better
understand options for immobilization as well as clinical clearance guidelines for
prehospital care providers. There is recent evidence to suggest better neurologic
outcomes and reduced mortality among children who are transported directly to a
pediatric trauma center when there is a suspected cervical spine injury.
There is also limited definitive evidence with regard to in-hospital clinical
clearance and radiographic imaging of the pediatric cervical spine. Several authors
have attempted to devise criteria to limit the use of cervical spine radiographs
because the number of positive studies constitutes a small proportion of the total
number of radiographic studies completed. The literature suggests that if the
