Implementation of pediatric cervical spine clearance guidelines at a combined trauma center: Twelve-month impact

J Trauma Acute Care Surg. 2015 Jun;78(6):1117-21. doi: 10.1097/TA.0000000000000643.


Background: Pediatric cervical spine clearance guidelines should reduce computed tomography (CT) usage in combined pediatric and adult trauma centers biased by adult CT clearance.

Methods: Cervical spine clearance under age 15 years was compared 12 months before (128 patients) and after (105 patients) guideline implementation, emphasizing National Emergency X-Radiography Utilization Study (NEXUS) criteria when appropriate.

Results: CT scans in patients clearable by NEXUS criteria decreased 23% (p = 0.01) and decreased by 16% in cases where radiography other than CT was indicated by guidelines (p = 0.01).

Conclusion: Guideline implementation can have an immediate effect in decreasing pediatric cervical spine CT usage and should improve across time.

Level of evidence: Care management study, level IV.

MeSH terms

  • Adolescent
  • Cervical Vertebrae / injuries*
  • Child
  • Child, Preschool
  • Clinical Protocols*
  • Female
  • Humans
  • Injury Severity Score
  • Male
  • Retrospective Studies
  • Spinal Injuries / diagnostic imaging*
  • Time Factors
  • Tomography, X-Ray Computed / statistics & numerical data*
  • Trauma Centers*