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Pediatric trauma population spine immobilization during resuscitation: A call for improved guidelines
Tessa Breeding1, Hazem Nasef1, Quratulain Amin1
1NOVA Southeastern University, Kiran Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA.
Insights
Spine immobilization in pediatric trauma patients leads to more imaging and higher admission rates, with inconsistent technique and frequent lapses. Further research is needed for optimal pediatric spinal immobilization practices.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Orthopedic Surgery
Background:
- Spine immobilization is a common practice for pediatric trauma patients.
- Current evidence on its efficacy and impact on outcomes is limited.
Purpose of the Study:
- To evaluate current practices of spine immobilization in pediatric trauma.
- To assess the efficacy, reliability, and clinical impact of these practices.
- To guide future research and evidence-based guidelines.
Main Methods:
- Systematic review of studies on pediatric spinal immobilization.
- Databases searched: PubMed, ProQuest, Embase, Google Scholar, Cochrane.
- Outcomes assessed: imaging frequency, pain, ED length of stay, disposition.
Main Results:
- Immobilized children had higher rates of cervical spine imaging (OR 8.2), floor admission (OR 4.0), ICU/OR admission (OR 5.3), and pain scores.
- Older children were more likely to be immobilized.
- No technique achieved consistent neutral positioning; 71.4% of patients experienced immobilization lapses.
Conclusions:
- Pediatric spinal immobilization is associated with increased imaging, higher admission rates, and greater pain.
- Immobilization practices are inconsistent, with frequent lapses and poor alignment.
- Further research is required to determine optimal techniques and indications for pediatric spinal immobilization.
Introduction:
This review aims to evaluate current practices regarding spine immobilization in pediatric trauma patients to evaluate their efficacy, reliability, and impact on clinical outcomes to guide future research and improved evidence-based practice guidelines.
Methods:
PubMed, ProQuest, Embase, Google Scholar, and Cochrane were queried for studies pertaining to spinal immobilization practices in pediatric trauma patients. Articles were separated into studies that explored both the efficacy and clinical outcomes of spine immobilization. Outcomes evaluated included frequency of spinal imaging, self-reported pain level, emergency department length of stay (ED-LOS), and ED disposition.
Results:
Six articles were included, with two studies examining clinical outcomes and 4 studies evaluating the efficacy and reliability of immobilization techniques. Immobilized children were significantly more likely to undergo cervical spine imaging (OR 8.2, p < 0.001), be admitted to the floor (OR 4.0, p < 0.001), be taken to the ICU or OR (OR 5.3, p < 0.05) and reported a higher median pain score. Older children were significantly more likely to be immobilized. No immobilization techniques consistently achieved neutral positioning, and patients most often presented in a flexed position. Lapses in immobilization occurred in 71.4% of patients.
Conclusion:
Immobilized pediatric patients underwent more cervical radiographs, and had higher hospital and ICU admission rates, and higher mean pain scores than those without immobilization. Immobilization was inconsistent across age groups and often resulted in lapses and improper alignment. Further research is needed to identify the most appropriate immobilization techniques for pediatric patients and when to use them.
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