Heterogeneity in cervical spine assessment in paediatric trauma: A survey of physicians' knowledge and application at a paediatric major trauma centre

Aaron J Buckland; Silvia Bressan; Helen Jowett; Michael B Johnson; Warwick J Teague

doi:10.1111/1742-6723.12650

Heterogeneity in cervical spine assessment in paediatric trauma: A survey of physicians' knowledge and application at a paediatric major trauma centre

Emerg Med Australas. 2016 Oct;28(5):569-74. doi: 10.1111/1742-6723.12650. Epub 2016 Jul 28.

Authors

Aaron J Buckland^{1

2}, Silvia Bressan^{3

4

5}, Helen Jowett³, Michael B Johnson¹, Warwick J Teague^{6

7

8}

Affiliations

¹ Department of Orthopaedics, The Royal Children's Hospital, Melbourne, Victoria, Australia.
² NYU Langone Medical Center - Hospital for Joint Diseases, New York, New York, USA.
³ Trauma Service, The Royal Children's Hospital, Melbourne, Victoria, Australia.
⁴ Emergency Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
⁵ Department of Woman's and Child's Health, University of Padova, Padova, Italy.
⁶ Trauma Service, The Royal Children's Hospital, Melbourne, Victoria, Australia. warwick.teague@rch.org.au.
⁷ Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia. warwick.teague@rch.org.au.
⁸ Surgical Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia. warwick.teague@rch.org.au.

PMID: 27474412
DOI: 10.1111/1742-6723.12650

Abstract

Objective: Evidence-based decision-making tools are widely used to guide cervical spine assessment in adult trauma patients. Similar tools validated for use in injured children are lacking. A paediatric-specific approach is appropriate given important differences in cervical spine anatomy, mechanism of spinal injury and concerns over ionising radiation in children. The present study aims to survey physicians' knowledge and application of cervical spine assessment in injured children.

Methods: A cross-sectional survey of physicians actively engaged in trauma care within a paediatric trauma centre was undertaken. Participation was voluntary and responses de-idenitified. The survey comprised 20 questions regarding initial assessment, imaging, immobilisation and perioperative management. Physicians' responses were compared with available current evidence.

Results: Sixty-seven physicians (28% registrars, 17% fellows and 55.2% consultants) participated. Physicians rated altered mental state, intoxication and distracting injury as the most important contraindications to cervical spine clearance in children. Fifty-four per cent considered adequate plain imaging to be 3-view cervical spine radiographs (anterior-posterior, lateral and odontoid), whereas 30% considered CT the most sensitive modality for detecting unstable cervical spine injuries. Physicians' responses reflected marked heterogeneity regarding semi-rigid cervical collars and what constitutes cervical spine 'clearance'. Greater consensus existed for perioperative precautions in this setting.

Conclusions: Physicians actively engaged in paediatric trauma care demonstrate marked heterogeneity in their knowledge and application of cervical spine assessment. This is compounded by a lack of paediatric-specific evidence and definitions, involvement of multiple specialties and staff turnover within busy departments. A validated decision-making tool for cervical spine assessment will represent an important advance in paediatric trauma.

Keywords: cervical spinal clearance; child; decision-making; healthcare surveys; spine injury.

MeSH terms

Cervical Vertebrae / injuries*
Child
Cross-Sectional Studies
Female
Humans
Male
Practice Patterns, Physicians' / statistics & numerical data*
Spinal Injuries / diagnosis*
Spinal Injuries / therapy
Surveys and Questionnaires
Trauma Centers
Victoria