The usefulness of a modified adult protocol for the clearance of XXXX in the emergency department.

@entity1 @entity130
OBJECTIVE: To determine if the use of a modified adult protocol that uses cervical spine imaging on presentation for the assessment of cervical @entity130 in @entity1 improves clinical outcome. METHODS: This is a case series study on all consecutive @entity130 @entity1 presenting from April to July 2000 inclusive to the ED of a major paediatric @entity130 hospital. @entity1 presenting to the ED with potential cervical @entity130 (CSI) were identified using standard selection criteria. @entity1 demographics, mechanism of injury, method and time of presentation, associated injuries, radiological investigation and clinical outcome were recorded. The major outcome measures for this study were: time to clearance of the cervical spine, length of stay in the ED and admission to an in-hospital bed. Data were analysed for compliance to the protocol, this being the standard assessment pathway of cervical spine clearance used by our @entity130 service. RESULTS: The @entity130 registry identified 1721 @entity130 presentations during the 4-month study period; 208 presentations representing 200 @entity1 with potential CSI were entered into the study. Males represented 72.5% of the study population, having a mean age of 8.32 years, although 29% were less than 5 years of age. The majority of presentations (69%) occurred outside of normal working hours. In 17.8% of cases the cervical spine was cleared based on clinical assessment alone, half less than 5 years of age. Compliance to the protocol occurred in 78% of presentations. However, when examined by age group, @entity1 5 years of age or above were 1.5 times more likely to comply with the protocol as compared with younger @entity1 . Adequate plain imaging was not obtained in 18% of presentations, this group almost exclusively less than 5 years of age. There were no missed injuries and no short or long-term neurological sequelae reported during this study. There were no differences in time to clearance, length of stay and admission rate between compliant and non-compliant groups. CONCLUSIONS: Modified adult protocols for cervical spine clearance offer guidance in managing the majority of @entity1 suffering blunt @entity130 . However, we recommend caution in rigidly applying such protocols, especially to @entity1 of young age.
