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C-spine Clearance in an Unreliable Patient (Cincinnati Children’s)
Topic overview
Clinical algorithm for cervical spine evaluation in pediatric trauma patients with unreliable examinations (GCS≤4, intubated, or intoxicated). Provides stepwise imaging protocol from plain radiographs through CT and MRI, with criteria for neurosurgical consultation and collar removal based on clinical reliability and imaging findings.
Key Takeaways
- Unreliable patients (GCS verbal ≤4, intubated, or intoxicated) require cervical collar and imaging—clinical exam alone is insufficient
- Normal C-spine X-rays in unreliable patients warrant CT within 24 hours; if still unreliable, proceed to MRI within 72 hours
- Clinical clearance requires ALL four criteria: normal neuro exam, no tenderness, no pain with ROM, and no distracting injuries
- Escalate abnormal imaging at any stage (X-ray, CT, or MRI) to neurosurgery consultation with collar maintained
- Only remove collar after normal MRI in persistently unreliable patients or after clinical clearance once patient becomes reliable
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How to cite: GlobalCastMD. C-spine Clearance in an Unreliable Patient (Cincinnati Children’s). GlobalCastMD Medical Library. https://library.globalcastmd.com/guideline/1850
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