American Academy of Pediatrics – Section on Neurological Surgery
View all recommendations from this societyMarch 15, 2021Consideration should be given to avoid unnecessary radiation exposure when appropriate. For instance, CDM tools incorporate 3 or more variables from history, physical examination, or simple clinical tests to guide patient management. Results from the National Emergency X-Radiography Utilization Study (NEXUS) and the Pediatric Emergency Care Applied Research Network (PECARN) provide a high negative predictive value for significant cervical spine injuries in pediatric patients. Low-risk criteria from NEXUS include: no posterior midline cervical spine tenderness; no evidence of intoxication; normal level of consciousness; no focal neurological deficit; and no painful distracting injuries. PECARN developed a model that was highly sensitive for a normal cervical spine in the absence of: altered mental status, focal neurologic findings, neck pain, torticollis, substantial torso injury, conditions predisposing to cervical spine injury, high-risk motor vehicle crash, and diving. In comparison to NEXUS, the PECARN model takes into account mechanism of injury and specific extent and location of other associated injuries.
Do not obtain imaging of the cervical spine following trauma in an awake and alert patient without considering the use of clinical decision making (CDM) tools for cervical spine clearance.
Consideration should be given to avoid unnecessary radiation exposure when appropriate. For instance, CDM tools incorporate 3 or more variables from history, physical examination, or simple clinical tests to guide patient management. Results from the National Emergency X-Radiography Utilization Study (NEXUS) and the Pediatric Emergency Care Applied Research Network (PECARN) provide a high negative predictive value for significant cervical spine injuries in pediatric patients. Low-risk criteria from NEXUS include: no posterior midline cervical spine tenderness; no evidence of intoxication; normal level of consciousness; no focal neurological deficit; and no painful distracting injuries. PECARN developed a model that was highly sensitive for a normal cervical spine in the absence of: altered mental status, focal neurologic findings, neck pain, torticollis, substantial torso injury, conditions predisposing to cervical spine injury, high-risk motor vehicle crash, and diving. In comparison to NEXUS, the PECARN model takes into account mechanism of injury and specific extent and location of other associated injuries.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
The pediatric neurosurgery Choosing Wisely topics were chosen after discussion among the Section on Neurological Surgery (SONS) Executive Committee members regarding the most common pediatric neurosurgery issues and treatments general pediatricians see in their practices. Various expert committees and sections of the AAP reviewed and approved the list. The AAP Executive Committee then granted final approval of the list.
AAP’s disclosure and conflict of interest policy can be found at www.aap.org.
Sources
Hoffman JR, Mower WR, Wolfson AB, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000;343(2):94-99
Leonard JC, Kupperman N, Olsen C, et al. Factors associated with cervical spine injury in children after blunt trauma. Ann Emerg Med; 2011;58(2):145-155
