Emergency Department and PICU Clinical Pathway for Evaluation/Treatment of Children with Suspected Traumatic Spinal Cord Injury
Initial Assessment
- Trauma Activation Pathway as indicated
- Mechanisms associated with increased risk of SCI
- Signs/Symptoms of SCI
- Spinal immobilization, including cervical collar
- Imaging Recommendations
Initial Medical Management
- Avoid hypotension
- Consider therapeutic hypertension
- SpO2 > 92% – < 98%
- Normothermia
- Steroids rarely indicated, discuss use with neurosurgery
Admit PICU
Ongoing Medical Management
- Maintain initial goals
- Avoid hypotension
- Consider therapeutic hypertension
- SpO2 92–98%
- Normothermia
- Avoid hypotension
- Prevent secondary injury
- DVT and pressure injury prevention
- Neurogenic bladder and bowel care
- Nutrition, rehab readiness, and pain management
- Prevent complications
Transfer to floor
Transfer to Rehab Facility
Evidence
- Neurogenic Bowel and Management After Spinal Cord Injury
- Neurogenic Bladder Physiology, Pathogenesis, and Management After Spinal Cord Injury
- Early Acute Management in Adults with Spinal Cord Injury
- Acute Traumatic Spinal Cord Injury
- Pediatric Spinal Cord Injury
- Spinal Cord Injuries in Children and Adolescents
- Rehabilitation of a Child with a Spinal Cord Injury
- Spine Injuries in Polytraumatized Pediatric Patients: Characteristics and Experience from a Level I Trauma Center Over Two Decades
- Spinal Cord Injury—What Are the Controversies?
- Update on Critical Care for Acute Spinal Cord Injury in the Setting of Polytrauma
- Surgical Timing for Cervical and Upper Thoracic Injuries in Patients with Polytrauma
- Building Consensus for the Medical Management of Children with Moderate and Severe Acute Spinal Cord Injury
- The Impact of Blood Pressure Management After Spinal Cord Injury
- Correlation of Shoulder Range of Motion Limitations at Discharge with Limitations in Activities and Participation One Year Later in Persons with Spinal Cord Injury
- Effects of Early Mobilization within 48 Hours of Injury in Patients with Incomplete Cervical Spinal Cord Injury
