UMEM Educational Pearls

Category: Pediatrics

Title: Cervical spine clearance in pediatrics

Keywords: cervical spine, pediatrics, NEXUS (PubMed Search)

Posted: 9/19/2014 by Jennifer Guyther, MD (Updated: 6/14/2024)
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The NEXUS criteria is widely applied to adults who present with neck pain due to trauma.  While this study did include about 2000 pediatric patients, there were not enough young children to draw definitive conclusions.  For more information on the evaluation of the cervical spine, see Dr. Rice's pearl from 9/7/12.  A 2003 study piloted an algorithm for cervical spine clearance in children < 8 years.

Patients were spine immobilized if: unconscious, abnormal neurological exam, history of transient neurological symptoms, significant mechanism of injury, neck pain, focal neck tenderness or inability to assess based on distracting injury (extremity or facial fractures, open wound, thoracic injuries, or abdominal injuries), physical exam findings of neck trauma, unreliable exam due to substance abuse, significant trauma to the head or face, or inconsolable children.

When the 2 pathways (see attached) were implemented, there was a decrease in time to cervical spine clearance.  There were no missed injuries in the study period prior to implementation of the pathway or once it was implemented.  There was no significant difference in the amount of xrays, CT scans or MRIs.


Lee S, Sena M, Greenholtz, S, Fledderman M.  A Multidisciplinary Approach to the Development of a Cervical Spine Clearance Protocol: Process, Rationale, and Initial Results.  Journal of Pediatric Surgery 2003; 38 (3): 358-362.


1409192317_Cspine_clearence_pathway.docx (52 Kb)