scholarly journals Using cervical spine clearance guidelines in a pediatric population: a survey of physician practices and opinions

CJEM ◽  
2011 ◽  
Vol 13 (01) ◽  
pp. 1-6 ◽  
Author(s):  
Emma C. Burns ◽  
Natalie L. Yanchar
Keyword(s):  
Cervical Spine ◽  
Design Method ◽  
Pediatric Population ◽  
Trauma Team ◽  
Pediatric Emergency ◽  
Team Leaders ◽  
Physician Practices ◽  
Clinical Criteria ◽  
Radiologic Imaging ◽  
National Emergency

ABSTRACT Background: Unlike in adults, there are currently no standardized, validated guidelines to aid practitioners in clearing the pediatric cervical spine (C-spine). Many pediatric centres in Canada have locally produced, adult-modified guidelines, but the extent to which these or other guidelines are used is unknown. Objective: The purpose of this study was to determine if Canadian physicians are using either locally produced or adult C-spine guidelines to clear the C- spines of patients < 16 years of age. The study also characterized the common methods used by physicians to clear pediatric C-spine injuries in terms of clinical examination and radiologic imaging. Methods: A 20-question survey was distributed to 240 Canadian pediatric emergency physicians and trauma team leaders using the Dillman Total Design Method. Results: The response rate was 68%. The results showed that 61% of physicians currently use guidelines to assist in the clearance of pediatric C-spines. Of those physicians not using guidelines, 85% stated that they would use them if they were available. The clinical criteria most often used to clear pediatric C-spines were a normal neurologic examination (97%) and the absence of C-spine tenderness (95%), intoxication (94%), and distracting injuries (87%). Conclusions: Guidelines are commonly used by Canadian physicians when clearing the pediatric C-spine, yet few are validated in children. Those most commonly used are locally developed guidelines, the Canadian C-spine guidelines, or National Emergency X-Radiography Utilization Study (NEXUS) low-risk criteria.

Prevalence of midline cervical spine tenderness in the non-trauma population

2021 ◽  
pp. emermed-2021-211288
Author(s):  
J Scott Delaney ◽  
Ammar Al-Kashmiri ◽  
Abdulaziz Alalshaikh ◽  
Saif Al-Ghafri ◽  
Sanjeet Singh Saluja ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Decision Rules ◽  
Clinical Decision ◽  
Neck Trauma ◽  
Factors Associated ◽  
Trauma Population ◽  
Spine Imaging ◽  
High Prevalence ◽  
National Emergency ◽  
Upper Third

ObjectiveThe Canadian C-Spine Rule (CCR) and the National Emergency X-Radiography Utilization Study (NEXUS) criteria are two commonly used clinical decision rules which use midline cervical spine (c-spine) tenderness on palpation as an indication for c-spine imaging post-trauma. This study was undertaken to determine the prevalence and location of midline c-spine tenderness in the non-trauma population.MethodsWe prospectively evaluated consenting adult patients presenting to an urban ED or university sport medicine clinic in Montreal, Canada between 2018 and 2020 for atraumatic non-head and neck-related reports over a 20-month period. The presence and location of pain during midline c-spine palpation as assessed by two examiners during separate evaluations was recorded. Patient information such as age, neck length and circumference, gender, body mass index (BMI) and scaphoid tenderness was also collected.ResultsOf 478 patients enrolled, 286 (59.8%) had midline c-spine tenderness on palpation with both examiners. The majority of those with tenderness were female (70.6%). When examining all patients, tenderness was present in the upper third of the c-spine in 128 (26.8%) patients, middle third in 270 (56.5%) patients and lower third in 6 (1.3%) patients. Factors associated with having increased odds of midline c-spine tenderness on palpation included a lower BMI and the presence of scaphoid tenderness on palpation.ConclusionsThere is a high prevalence of c-spine tenderness on palpation in patients who have not undergone head or neck trauma. This finding may help explain the low specificity in some of the validation studies examining the CCR and the NEXUS criteria.

Experienced trauma team leaders save the lives of multiple-trauma patients with severe head injuries

Surgery Today ◽  
2018 ◽  
Vol 49 (3) ◽  
pp. 261-267
Author(s):  
Zhi-Jie Hong ◽  
Cheng-Jueng Chen ◽  
De-Chuan Chan ◽  
Teng-Wei Chen ◽  
Jyh-Cherng Yu ◽  
...  
Keyword(s):  
Multiple Trauma ◽  
Head Injuries ◽  
Trauma Team ◽  
Trauma Patients ◽  
Team Leaders ◽  
Multiple Trauma Patients

scholarly journals Short‐term outcomes in children following emergency department visits for minor injuries sustained at home

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Matthew J Molloy ◽  
Wendy Shields ◽  
Molly W Stevens ◽  
Andrea C Gielen
Keyword(s):  
Emergency Department ◽  
Pediatric Population ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
Short Term ◽  
Minor Injury ◽  
Minor Injuries ◽  
A Minor ◽  
The Impact ◽  
At Home

Abstract Background Minor injuries are very common in the pediatric population and often occur in the home environment. Despite its prevalence, little is known about outcomes in children following minor injury at home. Understanding the impact of these injuries on children and their families is important for treatment, prevention, and policy. The objectives of our study were (1) To describe the distribution of short-term outcomes following pediatric minor injuries sustained at home and (2) To explore the relationship of injury type and patient and household demographics with these outcomes. Methods Children (n = 102) aged 0–7 years with a minor injury sustained at home were recruited in an urban pediatric emergency department as part of the Child Housing Assessment for a Safer Environment (CHASE) observational study. Each patient had a home visit following the emergency department visit, where five parent-reported outcomes were assessed. Relationships were explored with logistic regression. Results The most common type of injury was soft tissue (57.8 %). 13.2 % of children experienced ≥ 7 days of pain, 21.6 % experienced ≥ 7 days of abnormal activity, 8.9 % missed ≥ 5 days of school, 17.8 % of families experienced ≥ 7 days of disruption, and 9.1 % of parents missed ≥ 5 days of work. Families reported a total of 120 missed school days and 120 missed work days. Children who sustained a burn had higher odds of experiencing pain (OR 6.97), abnormal activity (OR 8.01), and missing school (OR 8.71). The parents of children who sustained a burn had higher odds of missing work (OR 14.97). Conclusions Families of children suffering a minor injury at home reported prolonged pain and changes in activity as well as significant school and work loss. In this cohort, burns were more likely than other minor injuries to have these negative short-term outcomes reported and represent an important target for interventions. The impact of these injuries on missed school and disruption of parental work warrants further consideration.

Clinical handover from emergency medical services to the trauma team: A gap analysis

CJEM ◽  
2020 ◽  
Vol 22 (S2) ◽  
pp. S21-S29
Author(s):  
Arshia P. Javidan ◽  
Avery B. Nathens ◽  
Homer Tien ◽  
Luis T. da Luz
Keyword(s):  
Emergency Medical Services ◽  
Gap Analysis ◽  
Trauma Team ◽  
Trauma Centre ◽  
Medical Services ◽  
Active Listening ◽  
Team Leaders ◽  
Process Measures ◽  
Team Members ◽  
Emergency Medical

ABSTRACTObjectivesThere has been limited evaluation of handover from emergency medical services (EMS) to the trauma team. We sought to characterize these handover practices to identify areas of improvement and determine if handover standardization might be beneficial for trauma team performance.MethodsData were prospectively collected over a nine-week period by a trained observer at a Canadian level one trauma centre. A randomized scheduled was used to capture a representative breadth of handovers. Data collected included outcome measures such as duration of handover, structure of the handover, and information shared, process measures such as questions and interruptions from the trauma team, and perceptions of the handover from nurses, trauma team leaders and EMS according to a bidirectional Likert scale.Results79 formal verbal handovers were observed. Information was often missing regarding airway (present 22%), breathing (54%), medications (59%), and allergies (54%). Handover structure lacked consistency beyond the order of identification and mechanism of injury. Of all questions asked, 35% were questioning previously given information. The majority of handovers (61%) involved parallel conversations between team members while EMS was speaking. There was a statistically significant disparity between the self-evaluation of EMS handovers and the perceived quality determined by nurses and trauma team leaders.ConclusionsWe have identified the need to standardize handover due to poor information content, a lack of structure and active listening, information repetition, and discordant expectations between team members. These data will guide the development of a co-constructed framework integrating the perspectives of all team members.

Evaluation of clinical criteria to determine the need for cervical spine imaging in victims of blunt assault

2020 ◽  
Vol 71 ◽  
pp. 84-88
Author(s):  
Joseph Chaudry ◽  
Nisha Swaminathan ◽  
Ruth K. Gershon ◽  
David P. Gordy ◽  
Lindsey Allred ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Clinical Criteria ◽  
Spine Imaging

Cervical spine alignment in the pediatric population: a radiographic normative study of 150 asymptomatic patients

2014 ◽  
Vol 23 (7) ◽  
pp. 1442-1448 ◽  
Author(s):  
K. Abelin-Genevois ◽  
A. Idjerouidene ◽  
P. Roussouly ◽  
J. M. Vital ◽  
C. Garin
Keyword(s):  
Cervical Spine ◽  
Pediatric Population ◽  
Normative Study ◽  
Asymptomatic Patients ◽  
Cervical Spine Alignment

scholarly journals Targeted Simulation-based Leadership Training for Trauma Team Leaders

2019 ◽  
Vol 20 (3) ◽  
pp. 520-526 ◽  
Author(s):  
Elizabeth Rosenman ◽  
Marie Vrablik ◽  
Sarah Brolliar ◽  
Anne Chipman ◽  
Rosemarie Fernandez
Keyword(s):  
Leadership Training ◽  
Trauma Team ◽  
Team Leaders ◽  
Simulation Based

Occipital condyle to cervical spine fixation in the pediatric population

2014 ◽  
Vol 13 (1) ◽  
pp. 45-53 ◽  
Author(s):  
Libby Kosnik-Infinger ◽  
Steven S. Glazier ◽  
Bruce M. Frankel
Keyword(s):  
Cervical Spine ◽  
Posterior Fossa ◽  
Pediatric Population ◽  
Occipital Bone ◽  
Occipital Condyle ◽  
Type I ◽  
Posterior Fossa Surgery ◽  
Clinical Scenarios ◽  
Spine Fixation ◽  
Cervical Spine Fixation

Fixation at the craniovertebral junction (CVJ) is necessary in a variety of pediatric clinical scenarios. Traditionally an occipital bone to cervical fusion is preformed, which requires a large amount of hardware to be placed on the occiput of a child. If a patient has previously undergone a posterior fossa decompression or requires a decompression at the time of the fusion procedure, it can be difficult to anchor a plate to the occipital bone. The authors propose a technique that can be used when faced with this difficult challenge by using the occipital condyle as a point of fixation for the construct. Adult cadaveric and a limited number of case studies have been published using occipital condyle (C-0) fixation. This work was adapted for the pediatric population. Between 2009 and 2012, 4 children underwent occipital condyle to axial or subaxial spine fixation. One patient had previously undergone posterior fossa surgery for tumor resection, and 1 required decompression at the time of operation. Two patients underwent preoperative deformity reduction using traction. One child had a Chiari malformation Type I. Each procedure was performed using polyaxial screw-rod constructs with intraoperative neuronavigation supplemented by a custom navigational drill guide. Smooth-shanked 3.5-mm polyaxial screws, ranging in length from 26 to 32 mm, were placed into the occipital condyles. All patients successfully underwent occipital condyle to cervical spine fixation. In 3 patients the construct extended from C-0 to C-2, and in 1 from C-0 to T-2. Patients with preoperative halo stabilization were placed in a cervical collar postoperatively. There were no new postoperative neurological deficits or vascular injuries. Each patient underwent postoperative CT, demonstrating excellent screw placement and evidence of solid fusion. Occipital condyle fixation is an effective option in pediatric patients requiring occipitocervical fusion for treatment of deformity and/or instability at the CVJ. The use of intraoperative neuronavigation allows for safe placement of screws into C-0, especially when faced with a challenging patient in whom fixation to the occipital bone is not possible or is less than ideal.

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