Practices in clearance of the pediatric cervical spine following blunt trauma: A Western Pediatric Cervical Spine Study analysis

BACKGROUND: Clearance of the pediatric cervical spine (CS) may pose a challenge following blunt trauma. Prior studies suggest that less than half of pediatric trauma centers (PTCs) have a written protocol for CS clearance. This study aimed to evaluate national practices for pediatric CS clearance in adult trauma centers (ATCs) and PTCs. METHODS: Western Pediatric Cervical Spine Study members were queried for hospital demographics and current CS clearance practices. Data included trauma center verification level and the number of yearly trauma activations. Study members provided information about CS clearance and included a copy of their CS clearance protocol, if applicable. Standalone PTCs were defined as level I or level II PTCs not combined with ATCs. RESULTS: Sixty-six of 80 institutions queried responded. Of 66 responding institutions, 15 were combined PTC/ATC, 16 were ATC only, and 36 were standalone PTCs (level I PTC, 29; level I ATC, 14; level II PTC, 5; level II ATC, 2; level III ATC, 1). The median number of pediatric (younger than 18 years) trauma admissions at each TC per year was 644 (interquartile range, 315-1,215). For CS clearance, 74% (49 of 66) of TCs had a written protocol. Standalone PTCs were more likely to have a written protocol (97% vs. 57%, p < 0.001) and require a magnetic resonance imaging for CS clearance in the obtunded patient (97.0% vs. 56.0%, p < 0.001). Among sites that had written CS clearance protocols, there were no differences between standalone PTCs and nonstandalone PTCs in the proportion of sites that included Nexus criteria, Canadian CS Rule, Pediatric Emergency Care Applied Research Network, mechanism of injury, Glasgow Coma Scale, or obtunded status. CONCLUSION: There is variation among adult and pediatric TCs in the screening and clearance of the pediatric CS. Despite evidence suggesting the importance of protocols for evaluating the CS, approximately half of the nonstandalone PTCs do not have an established protocol. ( J Trauma Acute Care Surg. 2026;100: 714-721. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Prognositc and Epidemiologic; Level IV.