Whilst minimising neck movement, gently palpate the posterior midline of the neck.Unexplained refractory hypotension (as a feature of spinal shock)Įxamining the cervical spine Prior to palpation, ask the patient if they have symptoms using age appropriate questions.Significant head, chest, abdominal or pelvic injuries (ie those that require admission, investigations or surgery).Cervical spine tenderness or significant neck pain.Subjective, transient or improving motor and sensory impairments are less concerning Concerning neurology: objective anatomical motor or sensory deficit.Child uses hand to support head or neck (this may be the only sign of an atlanto-occipital dislocation).be developmentally able to engage in the assessment process and maintain focus throughout the assessment.not heavily sedated by analgesia or sedatives.not significantly affected by alcohol or recreational drugs.Minimise movement of the potentially injured cervical spine, until the cervical spine is adequately assessed, and a targeted neurological examination performedįor an adequate examination a child must be awake and assessable. Persistent symptoms: pain, paraesthesia, weakness Examination Other rheumatological, genetic or metabolic conditions.Osteogenesis imperfecta, Achondroplasia.History of conditions known to predispose to CSI Fall >3 metres (or twice the patient’s height).Passenger in an MVC of >60 km/hr, head on collision, rollover, or any accident with a passenger death.Improper restraint in a motor vehicle collision (MVC).Ejection from a vehicle including motorbike.Forced neck hyperflexion (includes low velocity mechanism with high force eg rugby scrum collapse).Axial load to the head (diving, trampoline, falling from height).Thoracic elevation device and in a teenager head elevation device may be used Assessment History In a child under 8 years old this may be achieved by a Ideally the spine should be kept in a neutral position with the child lying flat. The aim is to minimise movement of the potentially injured spine. identify the cases where expert spinal services are required.clear the cervical spine in children who have sustained blunt trauma.This guideline is designed to assist and empower the clinician to: A validated clinical decision rule for the paediatric population does not exist.Avoid unnecessary immobilisation and imaging where possible Cervical spine assessment and the detection of CSI is difficult.This guideline is for cervical spine assessment only Hard collars have no proven patient benefit and are potentially harmful Foam collars are recommended (if the child will tolerate one) until CSI can be excluded.A senior clinician must assist in the assessment of children with persistent symptoms or who are unable to communicate Most cervical spines can be cleared clinically.Allowing excessive movement of an unstable CSI may lead to severe morbidity.Cervical spine injury (CSI) is uncommon in children.See also Trauma - the primary survey Head injury Thoracic elevation device Key Points

Primary survey x ray cervical spine