Aim To determine whether a single lateral cervical spine x-ray is sufficient to rule out significant pathology in children who have sustained a Cervical Spine Injury (CSI).

Methods 43,803 children presented to the Emergency Department of a busy children’s hospital between September 2013 and August 2014. These presentations were hand sorted to identify 334 children presenting following a neck injury. Demographic data was recorded for all of these children, as well as mechanism of injury. From these 334 children, 86 underwent a single cervical spine x-ray to exclude a cervical spine injury. The Radiology reports for all the cervical spine x-rays were reviewed as well as any subsequent imaging.

Results Of the 334 children presenting with neck injury the ratio of boys to girls was 2.6:1, the median age was 10, with a range of 2–14. The main mechanism of injury was a fall, accounting for 45% of presentations. Of those x-rayed, 79/86 of the children had a normal lateral cervical spine x-ray, 7 had an abnormal lateral cervical spine x-ray and required further imaging. 4 children underwent an MRI of the cervical spine, all of which were normal, 1child had an MRI and an AP of the cervical spine both of which were normal, 1 had a normal CT scan and 1 had a PEG view that was deemed inadequate. During the study period no fractures were identified, and no significant injuries were missed.

Conclusion This retrospective pilot study appears to show that a single lateral cervical spine x-ray in the first instance in children is safe, and would result in a reduction in radiation exposure. Due to the rare nature however of cervical spine injury in children and the catastrophic effects of a missed diagnosis means that a large prospective study would be required to validate these results.