Clearance Of The Cervical Spine In Obtunded Pediatric Blunt Trauma Patients: Quality Assessment Of An Existing Clearance Pathway
Rachel Kalthoff1, Elizabeth Boudiab2, Diane Studzinski2, Nathan Novotny3, Pavan Brahmamdam3, *Begum Akay3
1Oakland University William Beaumont School of Medicine, Rochester, MI;2Beaumont Health, Royal Oak, MI;3Beaumont Children's, Royal Oak, MI
Background (issue):Obtunded patients following blunt trauma need clearance of the cervical spine (c-spine) that cannot depend on a clinical exam. Our centerís current pediatric c-spine evaluation pathway includes both Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). The objective of this study was to review our use of both CT and MRI for obtunded pediatric trauma patients to assess the quality of our pathway and utility of MRI.
Methods:We performed a retrospective review of pediatric blunt trauma patients at our Level II Pediatric Trauma Center between January 2010 and December 2019. Patients age 0-18 with a Glasgow Coma Score (GCS) <10 were included. Patient charts were reviewed for age, sex, GCS, mode of injury, CT and MRI results, time from admission to CT and MRI, and c-spine treatments.
Findings: Forty-six patients met inclusion criteria with a median age of 13.5 (IQR 7-16) and median GCS of 4 (IQR 3-7). Forty-three patients had a normal c-spine CT. Of these, 16 patients received MRI due to persistent neurologic depression. MRI identified 3 injuries (18%) (Table 1). One patient required prolonged cervical collar immobilization and another required surgical immobilization with halo placement.
Conclusions (implications for practice):In obtunded patients, MRI adds value by identifying injuries needing intervention that were not seen on CT. These findings justify inclusion of MRI in our clinical pathway for pediatric c-spine clearance. This standardized pathway should lower the chance that unstable ligamentous injury is missed.
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