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Regarding the issue of c-spine films as a routine measure in significant
trauma, the pediatric literature is quite limited. Jerome Hoffman at UCLA
published a study a few years ago in adults which generated a nice
derivation set which he is currently validating prospectively in a 50,000
patient multicenter center (Hoffman JR et al. Ann Emerg Med
1992;21:1454--60). His criteria for using clinical exam alone were awake,
alert, non-intoxicated, no distracting injury, no midline or boney
tenderness over the c-spine. To the degree that this can be extrapolated
to children, I think these are good rules. The best pediatric work on
this topic has been, IMHO, has been: Rachesky et al. AJDC
1987:141:199-201 and Orenstein JB et al. Pediatrics 1992;89:1185-8. I
have worked in a peds ed with adult radiologists for 5 years. They also
insist on oblique views. In five years at a busy trauma center, the
obliques have not made a difference for our group.
 
Jay Fisher MD
 
UMC Ped Emergency Services
LV,NV
 
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