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Radiologic Imaging in Trauma Patients with Cervical Spine Immobilization at a Pediatric Trauma Center
Brandi C Barnes1, Pradip P Kamat2, Courtney M McCracken3
1Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
Insights
Procedural sedation and analgesia are often needed for pediatric trauma patients with cervical spine immobilization during imaging. Most patients required only one medication, with high success and few adverse events.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Anesthesiology
Background:
- Cervical spine (CS) immobilization in pediatric trauma patients often necessitates procedural sedation (PS) for imaging.
- Concerns exist regarding airway management during PS for CS-immobilized patients.
Purpose of the Study:
- To describe the utilization of PS and analgesia for radiologic imaging in pediatric trauma patients with CS immobilization.
Main Methods:
- Retrospective review of trauma patients with CS immobilization at a high-volume pediatric trauma center.
- Analysis of patient demographics, imaging, PS success, medications, and adverse events.
- Exclusion of intubated patients prior to emergency department arrival.
Main Results:
- 1417 patients and 1898 imaging encounters met inclusion criteria.
- 50.4% of patients required sedatives or analgesics, with 91.5% receiving a single agent.
- Airway obstruction occurred in 0.3% of sedated patients; all imaging procedures were successful.
Conclusions:
- Half of CS-immobilized, non-intubated pediatric trauma patients required only one sedative or analgesic for imaging.
- Procedural sedation for imaging in this population demonstrates high success rates and a low incidence of adverse events.
Background:
Pediatric trauma patients with cervical spine (CS) immobilization using a cervical collar often require procedural sedation (PS) for radiologic imaging. The limited ability to perform airway maneuvers while CS immobilized with a cervical collar is a concern for emergency department (ED) staff providing PS.
Objective:
To describe the use of PS and analgesia for radiologic imaging acquisition in pediatric trauma patients with CS immobilization.
Methods:
Retrospective medical record review of all trauma patients with CS immobilization at a high-volume pediatric trauma center was performed. Patient demographics, imaging modality, PS success, sedative and analgesia medications, and adverse events were analyzed. Patients intubated prior to arrival to the ED were excluded.
Results:
A total of 1417 patients with 1898 imaging encounters met our inclusion criteria. A total of 398 patients required more than one radiographic imaging procedure. The median age was 8 years (range 3.8-12.75 years). Computed tomography of the head was used in 974 of the 1898 patients (51.3%). A total of 956 of the 1898 patients (50.4%) required sedatives or analgesics for their radiographic imaging, with 875 (91.5%) requiring a single sedative or analgesic agent, and 81 (8.5%) requiring more than one medication. Airway obstruction was the most common adverse event, occurring in 5 of 956 patients (0.3%). All imaging procedures were successfully completed.
Conclusion:
Only 50% of CS immobilized, nonintubated patients required a single sedative or analgesic medication for their radiologic imaging. Procedural success was high, with few adverse events.
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