Cervical spine clearance in pediatric trauma patients - Consensus algorithm of the Pediatric Spinal Trauma Group of the Spine Section of the German Society for Orthopedic and Trauma Surgery (DGOU)

PURPOSE: Although cervical spine injuries in pediatric patients are rare, clinical and radiological examinations are clinical routine. Currently, no standardized decision algorithm does exist for detection of these injuries in the European region. The proposed algorithm is aiming to safely identify significant injuries through consistent diagnostics while minimizing immobilization and radiation exposure at the same time. METHODS: The Pediatric Spinal Trauma Group of the Spine Section of the German Society for Orthopedic and Trauma Surgery (DGOU) developed an algorithm based on own scientific investigations and considering primary and secondary literature. The algorithm was developed through a formal consensus process and thereby aligns with international recommendations. RESULTS: The algorithm uses the initial pediatric Glasgow Coma Scale (pGCS) to group patients to three treatment pathways. Resulting recommendations for imaging, clinical re-assessment, and further management include the child's age, trauma mechanism, and clinical evaluations. CONCLUSION: Despite their rarity, potential cervical spine injury in children requires accurate diagnosis. Clinical examinations can be challenging, especially in children with compromised consciousness. Increased radiation exposure from X-rays and computer tomography (CT) scans must be considered, particularly as magnetic resonance imaging (MRI) availability is sometimes limited and often requires more resources as sedation or anesthesia in younger children. The introduced algorithm uses standardized pathways for the diagnosis of pediatric cervical spine injuries aiming to reduce the number of missed injuries as well as diagnostic delays, minimize unnecessary radiation exposure, and optimize healthcare resource utilization. Spine Section of the German Society for Orthopedics and Trauma Surgery (DGOU).