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Accuracy of visual determination of neutral position of the immobilized pediatric cervical spine
H B Boswell1, A Dietrich, W E Shiels
1The College of Medicine and Public Health, The Ohio State University, Columbus, USA.
Insights
Physicians and paramedics often misjudge pediatric cervical spine immobilization, with 37% of cases not achieving neutral alignment despite visual agreement. This highlights a critical gap in pediatric emergency care for spinal injuries.
Area of Science:
- Pediatric Emergency Medicine
- Orthopedic Surgery
- Radiology
Background:
- Standardization of neutral position for immobilized pediatric cervical spines is lacking.
- Visual assessment accuracy and inter-observer reliability for pediatric cervical spine immobilization require investigation.
- Correlation between visual assessment and radiographic measurements of cervical spine alignment is not well-established.
Purpose of the Study:
- To evaluate the accuracy of visual assessment of pediatric cervical spine immobilization by physicians and paramedics.
- To determine the agreement between visual assessments of cervical spine positioning.
- To assess the correlation between visual assessment and radiographic Cobb angles.
Main Methods:
- Prospective study of children in full spinal immobilization in a pediatric emergency department.
- Independent visual assessment of cervical spine position by emergency physicians and paramedics.
- Radiographic Cobb angle measurement by a blinded radiologist.
Main Results:
- Physician and paramedic visual assessments of cervical spine position correlated in 88% of 59 children.
- Observers agreed on non-neutral Cobb angles in 100% of 22 cases, with 95% visually assessed as neutral.
- Radiographic analysis revealed 37% of cases did not achieve neutral cervical spine alignment.
Conclusions:
- Visual assessment of pediatric cervical spine immobilization by physicians and paramedics shows correlation.
- Despite observer agreement, radiographic evidence indicates frequent failure to achieve neutral cervical spine positioning.
- Improved methods are needed to ensure accurate neutral alignment in immobilized pediatric patients.
Background:
The definition of neutral position for the immobilized pediatric cervical spine is not well standardized. In this study, we attempted to determine whether 1) physicians and/or paramedics could accurately assess visually if the cervical spine was in a neutral position, 2) the visual assessments of the observers were in agreement, and 3) a radiographic Cobb angle would correlate with the visual determination.
Methods:
Children presenting to a pediatric emergency department (ED) in full spinal immobilization were randomly selected (convenience sample) for this prospective study. The emergency physician and transporting paramedic independently determined positioning of the cervical spine. A radiologist, blinded to clinical information, determined Cobb angles from radiographs of the immobilized cervical spines.
Results:
Of the 59 children studied, the evaluation of cervical spine position by the physician and paramedic correlated in 88% of the cases. For the 22 children with non-neutral Cobb angles (definition of neutral: between 5 degrees flexion and 5 degrees extension), observers agreed in 100% of the cases. However, in 21 of these cases (95%) the position was observed as neutral.
Conclusions:
Although visual determinations of neutral position of the cervical spine by two observers may correlate, radiographic studies demonstrate that neutral position was not achieved in 37% of the cases.
