Pediatric Cervical Collar Clearance — Evidence-Based Algorithm
Clinical Decision Tool · PICU Polytrauma

Pediatric cervical collar clearance.

An age-stratified, evidence-based pathway for safe collar removal in critically ill children. Built for the PICU polytrauma patient — where clinical exam is rarely fully reliable.

PECARN 2024 · PEDSPINE II · ACS Best Practices 2022 · ACR Appropriateness Criteria 2024
1Patient
2Reliability
3Imaging
4Decision

Evidence base

  1. Leonard JC, Harding M, Cook LJ, et al. PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. Lancet Child Adolesc Health. 2024.
  2. Luckhurst CM, Wiberg HM, Brown RL, et al. Pediatric cervical spine injury following blunt trauma in children younger than 3 years: the PEDSPINE II study. JAMA Surg. 2023.
  3. Lee LK, Ahmad FA, Browne LR, et al. Comparison of cervical spine injury clinical prediction rules for children after blunt trauma. JAMA Netw Open. 2025.
  4. Schroeder GD, Vaccaro AR, Welch WC, et al. Best Practices Guidelines: Spine Injury. American College of Surgeons. 2022.
  5. Melhado C, Durand R, Russell KW, et al. The sensitivity of limited-sequence MRI in identifying pediatric cervical spine injury: a Western Pediatric Surgery Research Consortium multicenter retrospective cohort study. J Trauma Acute Care Surg. 2024.
  6. Yong JH, Tan JH, Chen J, Hey HWD. CT versus MRI of the cervical spine in spinal clearance of trauma patients: a systematic review and meta-analyses. Eur Spine J. 2025.
  7. Russell KW, Kahan AM, Eldredge RS, et al. An analysis of potential cervical spine clearance in children with computed tomography alone. J Trauma Acute Care Surg. 2025.
  8. Kadom N, Palasis S, Pruthi S, et al. ACR Appropriateness Criteria: Suspected Spine Trauma — Child. J Am Coll Radiol. 2019, updated 2024.
  9. Marin JR, Lyons TW, Claudius I, et al. Optimizing advanced imaging of the pediatric patient in the emergency department: technical report. Pediatrics. 2024.
  10. Tavender E, Eapen N, Wang J, et al. Triage tools for detecting cervical spine injury in paediatric trauma patients. Cochrane Database Syst Rev. 2024.
  11. Palombi D, Galeazzi M, Brigato P, et al. Redefining pediatric SCIWORA: a systematic review of clinical patterns, imaging profiles, and management insights. J Clin Med. 2025.
  12. de Oliveira Manduca Palmiero H, Gadelha Figueiredo E. Cervical spine clearance in adult and pediatric trauma: a systematic review. J Emerg Med. 2026.
  13. Russell KW, Iantorno SE, Iyer RR, et al. Pediatric cervical spine clearance: a 10-year evaluation of multidetector CT at a Level 1 pediatric trauma center. J Trauma Acute Care Surg. 2023.