UMEM Educational Pearls

Category: Pediatrics

Title: Risk factors for pediatric cervical spine injuries

Keywords: MVC, neck injury, neurological injury (PubMed Search)

Posted: 7/24/2020 by Jenny Guyther, MD (Updated: 9/27/2022)
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There is no well validated clinical decision rule similar to NEXUS or the Canadian Cervical Spine rule in children for clearing the cervical spine.  Clinical clearance versus imaging first is a complicated decision.  Certain risk factors may predispose children to injury and should be taken into account when deciding about clinical clearance versus imaging (XR).

High Risk Criteria for Cervical Spine Injury in Pediatrics



High risk MVC

              Intrusion > 12 inches at the occupant site

              Intrusion > 18 inches at any site

              Partial or complete ejection

              Death in the same passenger compartment

              Vehicle telemetry consistent with high speed

Fall > 10 feet

Nonaccidental trauma

Diving injury



Down’s Syndrome

22.q11.2 deletion

Klippel-Fiel syndrome

Physical Exam


Altered mental status



Focal neurological exam

Neck pain










Gopinathan N, Viswanathan V, Crawford A.  Cervical Spine Evaluation in Pediatric Trauma: A Review and an Update of Current Concepts. Indian J Orthop 2018;52(5):489-500.

Leonard J, Browne L and Ahmed F et al.  Cervical Spine Injury Risk Factors in Children with Blunt Trauma.  Pediatrics 2019;144 (1):e20183221.

Kliegman R, Stanton B, St Geme J et al.  Nelson Textbook of Pediatrics.  20th edition Vol 1 and 2. 2016.  Elsevier. P 549-550, 3299-3300, 3352.