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Published on: January 5, 2015
Variability of prehospital spinal immobilization in children at risk for cervical spine injury
Emily G Kim1, Kathleen M Brown, Julie C Leonard
1Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA 95817, USA.
Insights
Prehospital spinal immobilization is inconsistently applied to young children with blunt trauma, even with cervical spine injury (CSI). Older children receive more consistent immobilization, highlighting a need for improved protocols in pediatric trauma care.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Care
- Spinal Immobilization Techniques
Background:
- Prehospital spinal immobilization is a critical intervention for pediatric blunt trauma patients.
- Current practices for immobilizing young children, particularly those under 2 years, require further investigation.
- Cervical spine injury (CSI) diagnosis in children can be challenging, impacting treatment decisions.
Purpose of the Study:
- To compare prehospital spinal immobilization techniques in children with and without cervical spine injury (CSI) after blunt trauma.
- To analyze age-based differences in immobilization practices for pediatric blunt trauma patients.
- To evaluate the consistency of full spinal immobilization in infants and young children.
Main Methods:
- Retrospective observational study of pediatric blunt trauma patients from multiple emergency departments and EMS systems.
- Comparison of immobilization techniques across three age cohorts: <2 years, 2-7 years, and 8-15 years.
- Statistical analysis using Fisher's exact test for homogeneity to compare immobilization methods.
Main Results:
- No significant difference in immobilization techniques for children under 2 years with or without CSI (P=0.34).
- Only 41% of children under 2 years with CSI received full immobilization (cervical collar and rigid long board).
- Significant differences in full immobilization rates between CSI patients under 2 years (38%) and older children (63% in 2-7 years, 79% in 8-15 years).
Conclusions:
- Full spinal immobilization is inconsistently applied to children under 2 years with blunt trauma, irrespective of CSI.
- Older children with CSI receive more consistent full spinal immobilization compared to younger children.
- Findings suggest a need to refine and standardize prehospital immobilization protocols for infants and young children in trauma care.
Objective:
This study aimed to compare prehospital spinal immobilization techniques applied to age-based cohorts of children with and without cervical spine injury (CSI) after blunt trauma.
Methods:
We compared prehospital spinal immobilization in 3 age-based cohorts of children with blunt trauma-related CSI transported to 1 of 17 participating hospitals. We also compared children younger than 2 years with CSI with those at risk for but without CSI after blunt trauma. We identified patients through query of billing and radiology databases. We compared immobilization methods using Fisher's exact test for homogeneity.
Results:
We identified 16 children younger than 2 years, 78 children 2 to 7 years old, and 221 children 8 to 15 years old with CSI, and 66 children younger than 2 years without CSI. There were no significant differences in spinal immobilization techniques applied to children younger than 2 years old with and without CSI (P = 0.34). Of the 82 children younger than 2 years, 34 (41%) were fully immobilized in a cervical collar and rigid long board. There was a significant difference between spinal immobilization techniques applied to children with CSI younger than 2 years and 8 to 15 years old (P < 0.01). Six (38%) children with CSI younger than 2 years were fully immobilized versus 49 (63%) children 2 to 7 years old and 175 (79%) children 8 to 15 years old.
Conclusions:
In this retrospective, observational study involving several emergency departments and Emergency Medical Services systems, we found that full spinal immobilization is inconsistently applied to children younger than 2 years after blunt trauma regardless of the presence of CSI. Full spinal immobilization is applied more consistently to older children with CSI.
