Paediatric cervical spine injuries: An audit of 22 acute injuries and literature review

SummaryAim:To describe patterns of injury, radiological evaluation and assessment of paediatric cervical spine injuries at our institution.Methods:We undertook an audit of cervical spine injuries over a 5-year period reviewing injury type, mechanism, radiological evaluation, and National Emergency X-Radiography Utilization Study decision instrument criteria at presentation [Hoffman JR, Wolfson AB, Todd K, Mower WR. Selective cervical spine radiology in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med 1998;32:461–9].Result:There were 22 children with cervical spine injuries. Nine children were injured during recreational activities, with seven injuries caused by motor vehicle accidents. There were 12 fractures, five spinal cord injury without radiographic abnormality (SCIWORA), four subluxation/dislocation injuries and one subluxation and fracture. Younger children (age less than 8) suffered injuries in the upper cervical spine. A positive diagnosis in the children with a fracture or subluxation injury was possible on plain films in all but two children. Using the NEXUS criteria, 14 of the 21 patients met at least one criterion on initial assessment.Conclusion:Our injury pattern is similar to that described in previous studies, although recreational activities were the leading mechanism of injury. Plain films were diagnostic in all but two of the fracture or subluxation injuries. The NEXUS decision instrument provides a good assessment of risk but has limitations when assessing young children