CJEM Articles: cervical-spine

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  • Using cervical spine clearance guidelines in a pediatric population: a survey of physician practices and opinions
    January 2011 13 1
    Emma C. Burns, Natalie L. Yanchar

    Background: Unlike in adults, there are currently no standardized, validated guidelines to aid practitioners in clearing the pediatric cervical spine (C-spine). Many pediatric centres in Canada have locally produced, adult-modified guidelines, but theextent towhichtheseorotherguidelinesareusedisunknown.

    Objective: The purpose of this study was to determine if Canadian physicians are using either locally produced or adult C-spine guidelines to clear the C- spines of patients , 16 years of age. The study also characterized the common methods used by physicians to clear pediatric C-spine injuries in terms of clinical examination and radiologic imaging.

    Methods: A 20-question survey was distributed to 240 Canadian pediatric emergency physicians and trauma team leaders using the Dillman Total Design Method.

    Results: The response rate was 68%. The results showed that 61% of physicians currently use guidelines to assist in the clearance of pediatric C-spines. Of those physicians not using guidelines, 85% stated that they would use them if they were available. The clinical criteria most often used to clear pediatric C-spines were a normal neurologic examination (97%) and the absence of C-spine tenderness (95%), intoxication (94%), and distracting injuries (87%).

    Conclusions: Guidelines are commonly used by Canadian physicians when clearing the pediatric C-spine, yet few are validated in children. Those most commonly used are locally developed guidelines, the Canadian C-spine guidelines, or National Emergency X-Radiography Utilization Study (NEXUS) low-risk criteria.

  • Canadian C-Spine Rule study for alert and stable trauma patients: II. Study objectives and methodology
    May 2002 4 3
    Andreas Laupacis, Brian Holroyd, Brian Rowe, Catherine M. Clement, Daniel Cass, Gary H. Greenberg, George A. Wells, Glen Bandiera, Howard Lesiuk, Iain MacPhail, Ian G. Stiell, James Worthington, Jonathan Dreyer, Laurie Morrison, Mark Reardon, Mary A. Eisenhauer, Michael Schull, R. Douglas McKnight, Richard Verbeek, Robert Brison

    Clinical prediction rules are decision-making tools that incorporate three or more variables from the history, physical examination or simple tests. They help clinicians make diagnostic or therapeutic decisions by standardizing the collection and interpretation of clinical data. There is growing interest in the methodological standards for their development and validation. This article describes the methods used to derive the Canadian C-Spine Rule and provides a valuable reference for investigators planning to develop future clinical prediction rules.