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Diagnosis of cervical spine injuries in children: a systematic review

  • Review Article
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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Objective

The objective of this systematic review was to discuss current knowledge of the diagnostic management of cervical spine (c-spine) injuries in children.

Methods

Studies dealing with this topic were collected from the following sources: MEDLINE via PubMed, Embase, and Cochrane. Where possible, a meta-analysis was performed. Furthermore, the level of evidence for all the included publications was assigned.

Results

The incidence of cervical spine injury (CSI) in children is rare (1.39 %). It seems that the upper c-spine is more often injured in children younger than 8 years of age. When a CSI is expected, immobilization should be performed. The best immobilization is achieved with a combination of a half-spine board, rigid collar, and tape. The literature for thoracic elevation or an occipital recess in children younger than 8 years of age is inhomogeneous. The c-spine in children can be cleared by a combination of the National Emergency X-Radiography Utilization Study (NEXUS) low-risk criteria and the Canadian C-Spine Rule. Caution is advised for nonverbal and/or unconscious children. In these children, plain radiographs should be performed. If these images are inadequate or show hints for bony injuries, a computed tomography (CT) of the c-spine should be considered. Additional views of the c-spine offer only little information for clearing the c-spine.

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Abbreviations

BCI:

Blunt carotid injury

BCVI:

Blunt cerebrovascular injuries

CAD:

Carotid artery dissections

CCR:

Canadian C-Spine Rule

CI:

Confidence interval

CSI:

Cervical spine injury

C-spine:

Cervical spine

CT:

Computed tomography

EAST:

Eastern Association for the Surgery of Trauma

ED:

Emergency room

GCS:

Glasgow Coma Scale

GoR:

Grade of recommendation

ICU:

Intensive care unit

ISS:

Injury Severity Score

LoE:

Level of Evidence

MRI:

Magnetic resonance imaging

MVA:

Motor vehicle accident

NEXUS:

National Emergency X-Radiography Utilization Study low-risk criteria

NPTR:

National Pediatric Trauma Registry

NTDB:

National Trauma Data Bank

SCI:

Spinal cord injury

SCIWORA:

Spinal cord injury without radiographic findings

vs.:

Versus

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There are no conflicts of interest and no sources of funding.

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Authors and Affiliations

  1. Department of Trauma Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany

    C. Schöneberg, B. Hussmann, M. D. Kauther, S. Lendemans & C. Waydhas

  2. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany

    B. Schweiger

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  1. C. Schöneberg
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Correspondence to C. Schöneberg.

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Schöneberg, C., Schweiger, B., Hussmann, B. et al. Diagnosis of cervical spine injuries in children: a systematic review. Eur J Trauma Emerg Surg 39, 653–665 (2013). https://doi.org/10.1007/s00068-013-0295-1

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  • DOI: https://doi.org/10.1007/s00068-013-0295-1

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