> I would appreciate any responses to the following questions regarding
> workup of the closed head injured pediatric patient. The population of
> patients that I am referring to would typically be a child in an MVA with
> an isolated CHI, without clinical evidence of spinal cord injury, severe
> enough to require mechanical ventilator support.
> 1. Are you able to clear the C-spine after intubation radiologically, or
> are pts kept in neck immobilization until after extubation and
> flexion-extension films can be obtained? If c/s clearance cannot be
> obtained, what radiographic studies are performed in the ED prior to
> disposition to ICU?
> Cannot clear C spine while intubated and with AMS. Just a lateral film in
> the ED to screen for gross instability fx/dislocation with continued
> c-spine precautions.
> 2. What is the typical radiologic imaging workup for the entire spine in
> an intubated pt. with a CHI (one may have to disinguish between those
> getting an ICP monitor and those who are not)
> Keep them immobilized regardless of radiologic imaging if not awake &
> alert. CT of the cervical spine would be the most informative for occult
> fx or ligamentous injury but cannot exclude SCIWORA without MRI. If
> patient has clinical evidence for spinal cord injury with the severe CHT
> like flaccid paralysis, decreased rectal tone, spinal shock, priapism etc
> I would pursue with an MRI.
> 3. Are there subsets of patients who do not get an entire spinal series?
> 4. What is the average LOS in ED for these patients?
> Depends on severity and nature of injury
> Could you give us details on the setting of your practice? ED/ICU etc
> Thanks in advance for any responses!
> Anne Morton, MD
> Raleigh, NC
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