Emergency Care - Injuries - Poisonings

Cervical spine injuries are uncommon in children. They are really not that uncommon in children, but because injuries to the C-spine in childhood are usually to the upper C-spine, they are frequently fatal. So if we were to look at trauma related fatalities
in young children, we would find quite a number of upper C- to see a child come in with a C-spine injury without a terribly morbid series of other injuries. The typical frontal impact in an automobile accident, where the head comes forward, that fulcrum being higher in the C-spine causes the injuries to be C1,C2 or C3 in a vast majority of children less than eight years of age. Once they are over eight, that fulcrum is down around C6. And after eight years of age, you'll see more of an adult pattern of C-spine injuries in children.
Every child who has had a bump on the head does not need C-
spine x-rays. We frequently will "clear" a C-spine clinically. However, if there is any question, we'll leave the collar in place and we will do radiographs. First of all, the child needs a normal level of consciousness. And people ask, "At what age does a child really have a normal level of consciousness?" A cooperative
four or five-year-old who can tell us that the
neck doesn't
hurt is in many cases a child whose neck can be cleared clinically. But again, the younger they are and the less cooperative, the less likely we are to trust the clinical approach for clearing
the C-spine after
a significant head injury. Of course, we want a
normal neurological examination. No neck pain and no neck tenderness. Any serious injury, any femur fracture or another very painful injury, can cause endogenous endorphin release and can cause a child to really be distracted from the neck injury. And so when a child says there is no neck pain when there is another very serious painful injury, we don't trust that the absence of reporting really means that the neck is not injured.
And then once we have gone through
these various parameters
we'll ask a child to fully move the neck voluntarily. If we've met
all of these criteria,
then we'll take the C-spine collar off
The presence of a collar when a child arrives to the Emergency Department does not obligate one to obtain C-spine films. Conversely, the fact that a child arrived in the Emergency Department without a collar doesn't mean it is inappropriate for
you to put one on if you think
is indicated. So we are not
required to continue what are perhaps the mistakes of others. I
would use your own independent judgement to determine whether
or not a collar should be placed or perhaps can be removed without radiographs.
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