Title: Risk factors for pediatric cervical spine injuries<br/>Author: Jenny Guyther<br/><a href='http://umem.org/profiles/faculty/314/'>[Click to email author]</a><hr/><p>
        There is no well validated clinical decision rule similar to NEXUS or the Canadian Cervical Spine rule in children for clearing the cervical spine.  Clinical clearance versus imaging first is a complicated decision.  Certain risk factors may predispose children to injury and should be taken into account when deciding about clinical clearance versus imaging (XR).</p>
<p>
        High Risk Criteria for Cervical Spine Injury in Pediatrics</p>
<table align="left" border="1" cellpadding="0" cellspacing="0">
        <tbody>
                <tr>
                        <td style="width:120px;">
                                <p>
                                        Mechanism</p>
                                <p>
                                         </p>
                        </td>
                        <td style="width:342px;">
                                <p>
                                        High risk MVC</p>
                                <p>
                                                      Intrusion > 12 inches at the occupant site</p>
                                <p>
                                                      Intrusion > 18 inches at any site</p>
                                <p>
                                                      Partial or complete ejection</p>
                                <p>
                                                      Death in the same passenger compartment</p>
                                <p>
                                                      Vehicle telemetry consistent with high speed</p>
                                <p>
                                        Fall > 10 feet</p>
                                <p>
                                        Nonaccidental trauma</p>
                                <p>
                                        Diving injury</p>
                        </td>
                </tr>
                <tr>
                        <td style="width:120px;">
                                <p>
                                        History</p>
                                <p>
                                         </p>
                        </td>
                        <td style="width:342px;">
                                <p>
                                        Down’s Syndrome</p>
                                <p>
                                        22.q11.2 deletion</p>
                                <p>
                                        Klippel-Fiel syndrome</p>
                        </td>
                </tr>
                <tr>
                        <td style="width:120px;">
                                <p>
                                        Physical Exam</p>
                                <p>
                                         </p>
                        </td>
                        <td style="width:342px;">
                                <p>
                                        Altered mental status</p>
                                <p>
                                        Intoxication</p>
                                <p>
                                        Hypotension</p>
                                <p>
                                        Focal neurological exam</p>
                                <p>
                                        Neck pain</p>
                                <p>
                                        Torticollis</p>
                        </td>
                </tr>
        </tbody>
</table>
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<fieldset><legend>References</legend>

                <p>
        Gopinathan N, Viswanathan V, Crawford A.  Cervical Spine Evaluation in Pediatric Trauma: A Review and an Update of Current Concepts. <em>Indian J Orthop</em> 2018;52(5):489-500.</p>
<p>
        Leonard J, Browne L and Ahmed F et al.  Cervical Spine Injury Risk Factors in Children with Blunt Trauma.  <em>Pediatrics</em> 2019;144 (1):e20183221.</p>
<p>
        Kliegman R, Stanton B, St Geme J et al.  Nelson Textbook of Pediatrics.  20^th edition Vol 1 and 2. 2016.  Elsevier. P 549-550, 3299-3300, 3352.</p>
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