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Cervical Collar-Associated Pressure Injury in Pediatric Trauma Patients: A Western Pediatric Surgery Research
Caroline Melhado1, Katie W Russell2, Shannon N Acker3
1University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA.
Insights
Healthcare-associated pressure injuries (HAPI) in children are rare when using cervical immobilization for spine injuries. Most cases occurred in patients needing immobilization for treatment, not prophylactic use.
Area of Science:
- Pediatric Trauma Care
- Medical Device-Associated Injuries
Background:
- Healthcare-associated pressure injuries (HAPI) are preventable injuries linked to medical devices.
- Cervical spine immobilization is common in pediatric trauma patients.
- HAPI frequency in children with cervical immobilization is not well-described.
Purpose of the Study:
- To characterize children who developed HAPI associated with cervical immobilization.
Main Methods:
- Retrospective cohort analysis of children (0-18 years) with stage II+ cervical HAPI.
- Data from 49,218 registry patients over five years (2017-2021) at ten pediatric trauma centers.
- Tabulation of patient demographics, injury characteristics, and immobilization details.
Main Results:
- 32 children developed stage II+ cervical HAPI; median age 5 years.
- 78% were in the ICU; median time to HAPI diagnosis was 11 days.
- Most HAPI (78%) occurred in children immobilized for cervical injuries; only 4 developed HAPI prophylactically.
Conclusions:
- Advanced-stage cervical HAPI in pediatric trauma patients is rare.
- HAPI typically occurs in patients with cervical spine injuries requiring immobilization.
- Expedited cervical spine clearance with MRI is unlikely to significantly reduce HAPI in this population.
Background:
Healthcare-associated pressure injuries (HAPI) are known to be associated with medical devices and are preventable. Cervical spine immobilization is commonly utilized in injured children prior to clinical clearance or for treatment of an unstable cervical spinal injury. The frequency of HAPI has been quantified in adults with cervical spine immobilization but has not been well-described in children. The aim of this study was to describe characteristics of children who developed HAPI associated with cervical immobilization.
Methods:
We analyzed a retrospective cohort of children (0-18 years) who developed a stage two or greater cervical HAPI. This cohort was drawn from an overall sample of 49,218 registry patients treated over a five-year period (2017-2021) at ten pediatric trauma centers. Patient demographics, injury characteristics, and cervical immobilization were tabulated to describe the population.
Results:
The cohort included 32 children with stage two or greater cervical HAPI. The median age was 5 years (IQR 2-13) and 78% (n = 25) were admitted to the intensive care unit. The median (IQR) time to diagnosis of HAPI was 11 (7-21) days post-injury. The majority of cervical HAPI (78%, 25/32) occurred in children requiring immobilization for cervical injuries, with only four children developing HAPI after wearing a prophylactic cervical collar in the absence of a cervical spine injury.
Conclusion:
Advanced-stage HAPI associated with cervical collar use in pediatric trauma patients is rare and usually occurs in patients with cervical spine injuries requiring immobilization for treatment. More expedient cervical spine clearance with MRI is unlikely to substantially reduce cervical HAPI in injured children.
Level Of Evidence:
Level III (Epidemiologic and Prognostic).
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