#paeds see: - [PECARN children blunt c-spine trauma prospective study lancet](bookends://sonnysoftware.com/ref/DL/280867) - [first10em review of this](cubox://card?id=7251297650065015951) - [web link](https://first10em.com/the-pecarn-c-spine-rule-could-cause-a-lot-of-harm/) - [RCH - cervical spine assessment](x-devonthink-item://EBB0C398-19F4-43F3-A7F7-C814C0E9E039) - [Cameron Paeds spinal injury](x-devonthink-item://F982582F-4A43-425B-9A32-8805799C4FE2?page=63) see also: [[Cervical spine trauma radiology#X-Ray|C-spine XR]], [[paediatric head trauma]] > [[Cervical spine trauma radiology#NEXUS]] can be used in kids, not Canadian C spine <16 **High risk** - axial load to head - forced neck hyperflexion - ejection from vehicle - MVC without restraint - MVC >60km/h - paed vs vehicle - fall >3m or 2x their height - fall or kick from horse - substantial torso injury - conditions known to predispose to c-spine injury: - prior c spine surgery - down's syndrome - osteogenesis imperfect - other rheumatological conditions **exam concerning features** - traumatic [[Torticollis]] - child uses hand to support head or neck - GCS <15 - c spine tenderness or significant neck pain - restricted neck movement - pain or paraesthesia rotating head - objective motor neurology or objective anatomical sensory alternation - less concerning is transient/improving or subjective sensory impairment # spinal immobilisation - do NOT use hard collar -- no evidence of improved outcome, and harm possibilities (↑ ICP, resp disturbance, patient agitation, soft tissue ulceration) - remove children from spinal boards - a thoracic elevation device should be used in children under 8 to help achieve neutral position - can use sand bags but no taping | spinal immobilisation consideration | strategy | | ---------------------------------------------------------------------- | ---------------------------------------------------------------------- | | larger occiput → neck flexed when impobilised on standard spinal board | thoracic elevation device children < 8 | | ↑ ICP, resp distress, airway obstruction | do not use hard collars in children | | short submental distance | | | desire to look around | parent at head of bed | | lack of tolerance of colar | consider letting infants find their own best position eg in mum's arms | # RCH management flowchart ![[Pasted image 20240726183549.png| RCH assessment flowchart]] # blunt spine trauma prediction rule ![[Pasted image 20240726183155.png]] Clinical algorithm for c-spine imaging in children after blunt trauma predicated on the PECARN cervical spine injury prediction rule # Differences between paeds + adult C spine XR - pseudo-subluxation of C2 on C3 - exaggerated atlanto-dens distance < 5mm - variable anterior soft tissue width altering with head-positioning and crying; - anterior wedging of the vertebral bodies (especially C3). - Loss of normal C spine lordosis # OSCE - [2024 Eastern Health station 3](x-devonthink-item://550BFF41-CA17-4CC3-A4DF-C45DB0593BC1)