The cervical spine can be cleared clinically with a 99.6% sensitivity and a 99.9% negative predictive value for clinically significant injury using the NEXUS criteria.
All five of the following criteria must be met
In a child with suspected cervical spine injury, failure to meet any one of the five criteria mandates imaging.
Pain-free range of motion and mechanism of injury should also be considered when deciding on the need for imaging of the cervical spine.
There were a relatively small number of children in the < 2 year age group in this study and caution must be used in applying the NEXUS criteria in this age group.
Canadian C-spine Rule
The Canadian C-spine rule excluded children under 16 years of age, but there is some evidence that the following ‘dangerous mechanism’ criteria are as relevant to children as it is to adults.
High mechanism (imaging indicated)
1. Who to immobilise?
Any child with a history of trauma with one or more of the following:
2. How to immobilise?
|Sizing a one piece Hard Collar:|
|Measure the distance from the top of the patient’s shoulder to the angle of the jaw with your hand|
|On the collar, measure from the bottom of the rigid plastic to the “measuring point” – adjust the collar to correspond with the same size as the angle of jaw to shoulder|
Apply the collar and check that it fits correctly:
Patient Transfers – when transferring a patient from the ED trolley to the ward bed:
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