Aaron Jensen

17 statements · 1 topic

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Children age 3 and under with high-risk mechanisms of injury, particularly child abuse, should be screened radiographically even if they appear totally fine, because C-spine injury rates are very high in child abuse.
guideline · Cervical Spine Injury
Clinical clearance of C-spine requires no neurologic deficits, no midline cervical tenderness, no painful distracting injury, no unexplained hypotension, and ability to move head in all directions without limitation.
guideline · Cervical Spine Injury

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Aaron's statements about Cervical Spine Injury 17 statements

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Statement Pediatric surgeons self-admittedly over-image C-spines in trauma, as demonstrated by show of hands in a room of pediatric surgery experts. Open
Quotation Show of hands, who thinks they over-image C-spines and trauma? Most of the room, right? And we're talking to a group of pediatric surgeons. So we are the experts in pediatric trauma, and we self-admittedly over-image. Open
Statement Children with GCS 14-15 who are not intoxicated can be cleared clinically for C-spine injury unless they have a painful distracting injury, according to AANS/CNS evidence-based guidelines from 2013. Open
Statement Children age 3 and under with high-risk mechanisms of injury, particularly child abuse, should be screened radiographically even if they appear totally fine, because C-spine injury rates are very high in child abuse. Open
Statement Clinical clearance of C-spine requires no neurologic deficits, no midline cervical tenderness, no painful distracting injury, no unexplained hypotension, and ability to move head in all directions without limitation. Open
Quotation I think of all the things I'm talking about today, this is the one problem that we as pediatric surgeons need to address. We need to take ownership of this problem, we need to take ownership of the over-imaging, over radiation of trauma patients at non-pediatric centers. Open
Quotation I think we in our own centers do a great job of not imaging kids that don't need imaging. But we need to get the word out. Open
Statement In a Boston study of 300 children with no fractures on ED imaging, only 2% had ligamentous injury on MRI and none required surgery, demonstrating safety of sending patients home in collar with follow-up. Open
Statement 84% of children sent home in a collar after normal initial imaging had their collar clinically cleared at first clinic visit 1-2 weeks later. Open
Statement Pressure ulcers from cervical collars occur in 6-38% of patients, most commonly in ICU patients who receive fluid resuscitation and require ventilation, with ulcers occurring on clavicles, back of head, and base of neck. Open
Statement Meta-analysis of 5 adult studies with 1000 patients showed that among those with completely normal CT scans, 9% had stable injuries on MRI requiring no treatment, and no patient required surgery. Open
Statement The adult recommendation to remove collars based on normal CT scan may not apply to children, who have greater frequency of ligamentous injury and unstable ligamentous injury. Open
Statement The ACS TQuip program offers a free downloadable resource with standardized evidence-based guidelines for imaging trauma patients, including pediatric-specific sections developed with input from five pediatric surgeons. Open
Quotation I hope you all got the memo that we are currently overutilizing imaging and underutilizing clinical clearance for pediatric trauma patients. Open
Statement For infants, clinical clearance requires certainty that the mechanism is not high-risk and that child abuse is not present, as clinical clearance has not been validated with high mechanism in young children. Open
Quotation I think that there are financial incentives to doing imaging. And I think there's also disincentive from a legal standpoint. If you miss a cervical spine injury and a kid has devastating neurologic injury that you miss, there is a huge legal liability there. Open
Quotation We need to come up with legal protections for following protocols and guidelines. If the data suggests that you don't need to order an expensive test and you miss an injury, you should somehow be protected because you did follow the standard of care. Open