In this section
This guideline has been adapted for statewide use with the support of the Victorian Paediatric Clinical Network
See also:Radiology guideline - Acute indications
This document provides a framework for assessment of a child with a possible cervical spine injury in Victorian hospitals.
All children under 16 years of age with major trauma (including confirmed or highly suspected spinal cord injury) should have ongoing management at Royal Children's Hospital.
Traumatic injuries of the cervical spine are uncommon in children. However in many circumstances it is prudent to assume there is a cervical spine injury until examination and radiological investigation prove otherwise.
It is often challenging to assess and immobilise children when a cervical spine injury is suspected.
All children should be taken off the spinal board as soon as possible, ideally at time of transfer from ambulance trolley.
If children are less than 8 years they should be placed on a mattress with a cut away head space or on an airway pad.
"A suitable folded airway pad allows for a child's large occiput and keeps spine in a neutral position."
Patients with suspected or possible cervical spine injury must have their cervical spine properly immobilised until formal assessment occurs.
Sand bags and tape are NO longer recommended in the hospital setting
Image 1: Measuring collar size on neck
Image 2: Checking collar size
Image 3: Appropriately fitting collar
Spinal assessment and management plan MUST be clearly documented. IF ABNORMAL NEUROLOGY – CONTACT RCH NEUROSURGERY IMMEDIATELY (03 9345 5522)
To be able to adequately assess the patient, he/she must:
If patient is unable to be assessed, immobilisation should be maintained in a hard collar.
Flowchart: Assessment of the Cervical Spine
Patients with possible cervical spine injury must have their cervical spine properly immobilised throughout assessment.
Two piece collars refers to – Aspen / Philadelphia two piece soft collars
It is imperative that the person making the clinical decision regarding clearing the c-spine has both examined the patient and viewed the films.
AP and Odontoid (Peg) view
Further imaging of C-Spine
(a) For patients being discharged:
(b) For admitted patients:
For further information, see Pressure ulcer prevention and management guideline
Consider consultation with local paediatric team:
When to consider transfer to tertiary centre:
For advice and inter-hospital (including ICU level) transfers ring the Sick Child Hotline: (03) 9345 7007
Information Specific for RCH
Documentation: Use the Major Trauma management record for documentation of spinal assessment and plan
Further imaging (including CT, MRI) must be discussed with the Emergency consultant or unit registrar and Medical Imaging fellow. Intubated patients requiring CT brain should be discussed with Neurosurgery. Patients with abnormalities on plain c-spine x-rays should be discussed with Orthopaedics.
Admission: Patients with multiple injuries are admitted under General Surgery with Neurosurgical and/or Orthopaedic input. Patients with isolated spinal cord injury are admitted under Neurosurgery. Patients without neurological signs, who cannot be cleared in the Emergency Department, should be discussed with the Orthopaedic team.
Information Specific for Southern Health
The neurosurgical unit at Monash Children’s provides a service for assessment of paediatric patients with brain and spinal injuries. All patients with suspected injury should be discussed with the neurosurgical unit (03 9594 6666).
Last updated December 2012
Please see our clinical practice guideline Immunisation of Outpatients
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