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In this study, we assessed detection rates of bony and ligamentous injuries in both initial MRI evaluation and subsequent FE radiography in pediatric patients presenting with risk factors for cervical spinal cord injury in the setting of acute trauma. 3 Although initial MRI cervical spine evaluation in adult patients has been associated with a false-positive rate of between 25% and 40%, 4 the effectiveness of MRI as an initial imaging modality for acute trauma followed by FE radiography has not been evaluated in the pediatric population. However, MRI has demonstrated high sensitivity for both osseous and ligamentous injuries while also avoiding unnecessary radiation exposure in the pediatric patient population. Prior studies provided mixed evidence to support the use of either MRI or CT in the setting of acute pediatric trauma. While the American College of Radiology (ACR) Appropriateness Criteria for Suspected Spine Trauma in pediatric patients offer guidelines for best imaging practices in the setting of acute trauma, 2 there is a lack of uniformity in imaging-decision protocols across institutions, resulting in variable use of CT, MRI, plain radiographs (PFs), and flexion-extension (FE) radiographs as initial and secondary imaging modalities. 1 Thus, prompt and accurate diagnostic imaging is crucial for reducing patient morbidity and mortality in cases in which cervical spinal cord injury (SCI) is suspected. If the spine is unlikely to be injured, hospital staff remove the collar and head supports.In pediatric blunt trauma patients, spinal cord injury without radiographic abnormality (SCIWORA) more commonly occurs in the cervical spine compared with the thoracic and lumbar regions. If the hospital staff think the person might have a spinal injury, they offer a scan. The same questions are asked again when the person arrives at the hospital. These questions include their age, the type of injury they have had and how they became injured. People with a possible spinal injury who have their spine immobilised to prevent further injury, using a special collar and head supports, are asked questions by the ambulance team to try to find out how likely it is that they have a spinal injury, and which part of the spine might be injured.

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The level of risk of cervical spine injury should be used to make decisions on whether spinal immobilisation and prompt imaging are needed.Ĭommissioners (integrated care systems and NHS England) ensure that they commission services that have checklists to document the use of the Canadian C‑spine rule to assess the risk of cervical spine injury for people with full in‑line spinal immobilisation, and inform decisions about when to carry out or continue with spinal immobilisation and request prompt imaging. A digital reference tool that contains the Canadian C‑spine rule, such as the MDCalc website, can be used when doing the assessment.

Healthcare professionals (paramedics and trauma teams) use the Canadian C‑spine rule to carry out risk assessment for people with full in‑line spinal immobilisation, and document this.

Service providers (ambulance services, major trauma centres, trauma units and district general hospitals) train staff in using the Canadian C‑spine rule and implement its use in pre‑hospital and hospital settings to carry out risk assessment for cervical spine injury for people with full in‑line spinal immobilisation. What the quality statement means for different audiences

Child cervical spine x ray