Cervical Spine Injury from Blunt Trauma Clinical Pathway – Emergency Department

Emergency Department Clinical Pathway for the Evaluation/Treatment
of Children with Suspected Cervical Spine Injury from Blunt Trauma

Goals and Metrics
Patient Education
Provider Resources

High-Risk Factors

  • GCS ≤ 8
  • Unresponsive on the Awake, Verbal, Pain or Unresponsive (AVPU) scale
  • Abnormal airway, breathing or circulation
  • Focal neurological deficits on examination

Non-Negligible Risk Factors

  • GCS 9–14
  • Verbal or Pain on AVPU scale
  • Head or torso injury warranting inpatient observation or surgical intervention
  • Self-reported midline neck pain
  • Midline neck tenderness on examination
Neck CTA Indications
Children with Suspected Cervical Spine
(C-Spine) Injury from Blunt Trauma
 
 
Triage
 
 
Evidence-Based Guidance for C-Spine Imaging

Team Assessment

 
 
 
 
 
 
 
No Risk Factors Present

Non-Negligible Risk Factor

  • Self-reported midline neck pain
  • Midline neck tenderness on exam

Non-Negligible Risk Factor

  • GCS 9–14
  • Verbal or Pain on AVPU scale
  • Head or torso injury warranting admission or surgical intervention
High-Risk Factors Present
 
 
 
 
 
 
 
 
Ibuprofen, Reassess
 
 
 
 
 
 
 
 
 
 
No midline pain or tenderness
Persistent midline pain or tenderness
CT without injury
CT with injury
 
 
 
 
 
 

Obtain X-rays

  • < 5 yrs: 2 view – C-spine A/P & Lateral
  • ≥ 5 yrs: 3 view – C-spine A/P, lateral and odontoid
NSGY Consult
 
 
 
 
 
 
X-ray without injury
X-ray with injury

Ongoing management

Disposition per Trauma
 
 
 
 
Reassess
 
 
 
 
  • Normal mental status
  • No other injury requiring admission
Abnormal mental status
or
Injury requiring admission
 
 
 
 
 
 
Clear C-Spine
 
 
Absent or improving midline pain or tenderness
Persistent midline pain or tenderness
 
 
 
 
≥ 8 yrs
< 8 yrs
 
 
Discharge
Discharge with
Aspen collar
  • Trauma consult
  • Disposition
    per Trauma
  • Consult Trauma, NSGY
  • CT vs. MRI
  • Disposition per Trauma
Follow up PCP as needed