Using cervical spine clearance guidelines in a pediatric population: a survey of physician practices and opinions

CJEM. 2011 Jan;13(1):1-6. doi: 10.2310/8000.2011.100220.


Background: Unlike in adults, there are currently no standardized, validated guidelines to aid practitioners in clearing the pediatric cervical spine (C-spine). Many pediatric centres in Canada have locally produced, adult-modified guidelines, but the extent to which these or other guidelines are used is unknown.

Objective: The purpose of this study was to determine if Canadian physicians are using either locally produced or adult C-spine guidelines to clear the C- spines of patients < 16 years of age. The study also characterized the common methods used by physicians to clear pediatric C-spine injuries in terms of clinical examination and radiologic imaging.

Methods: A 20-question survey was distributed to 240 Canadian pediatric emergency physicians and trauma team leaders using the Dillman Total Design Method.

Results: The response rate was 68%. The results showed that 61% of physicians currently use guidelines to assist in the clearance of pediatric C-spines. Of those physicians not using guidelines, 85% stated that they would use them if they were available. The clinical criteria most often used to clear pediatric C-spines were a normal neurologic examination (97%) and the absence of C-spine tenderness (95%), intoxication (94%), and distracting injuries (87%).

Conclusions: Guidelines are commonly used by Canadian physicians when clearing the pediatric C-spine, yet few are validated in children. Those most commonly used are locally developed guidelines, the Canadian C-spine guidelines, or National Emergency X-Radiography Utilization Study (NEXUS) low-risk criteria.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Canada
  • Cervical Vertebrae / injuries*
  • Emergency Service, Hospital
  • Guideline Adherence*
  • Health Care Surveys
  • Health Services Research
  • Humans
  • Middle Aged
  • Practice Guidelines as Topic*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Spinal Injuries / diagnosis*
  • Surveys and Questionnaires