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Updated: Jul 18, 2026
A Contusive Model of Unilateral Cervical Spinal Cord Injury Using the Infinite Horizon Impactor
Published on: July 24, 2012
Application of cervical spinal motion restriction to injured children in the prehospital setting
Sriram Ramgopal1, Caleb E Ward2, Alexander Rogers3
1Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America; Stanley Manne Children's Research Institute, Chicago, IL, United States of America.
Insights
Spinal motion restriction (SMR) was applied in 10.8% of injured children. Factors like older age, altered consciousness, and certain injuries influenced SMR use in prehospital care.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Care
- Prehospital Services
Background:
- Spinal motion restriction (SMR) is a critical procedure in pediatric trauma care.
- Improved data on SMR use is needed to refine prehospital guidelines for injured children.
Purpose of the Study:
- To evaluate the prevalence of SMR application in injured pediatric patients in the prehospital setting.
- To identify demographic and clinical factors associated with SMR use among these children.
Main Methods:
- Retrospective analysis of the 2022-2023 National Emergency Medical Services Information System (NEMSIS) datasets.
- Inclusion of injured pediatric ground encounters (<18 years) transported to the hospital.
- Multivariable analysis using a linear mixed effects model to determine associations with SMR application.
Main Results:
- Spinal motion restriction was applied in 10.8% (67,551 of 623,785) of injured children.
- Factors positively associated with SMR included older age, longer transport times, altered consciousness, high pain scores, advanced life support, tachycardia, tachypnea, bradypnea, pedestrian incidents, and non-traffic motor vehicle collisions.
- Hypotension and mechanisms like falls, penetrating trauma, and environmental injuries were negatively associated with SMR.
Conclusions:
- Multiple factors are associated with the application of spinal motion restriction in injured pediatric patients.
- These findings offer insights for evaluating current practices, monitoring trends, and assessing the impact of updated pediatric SMR guidelines in emergency medical services.
Objective:
Improved data on spinal motion restriction (SMR) use can improve pediatric prehospital guidelines and inform the appropriate use of this procedure. We sought to evaluate the prevalence and factors associated with SMR among injured children in the prehospital setting.
Methods:
We performed a retrospective analysis using retrospective data using the 2022-2023 National Emergency Medical Services Information System datasets, including injured pediatric (<18 years) ground encounters at the scene transported to the hospital. We identified the percentage of encounters for which SMR was applied. We identified demographic and clinical associations with SMR application using a linear mixed effects model.
Results:
We identified 623,785 encounters for injured children (median age 13 years, IQR 6-15; 55.5 % for boys). Among these, 67,551 (10.8 %) had SMR applied in the prehospital setting. In multivariable analysis, SMR use was positively associated (odds ratio, 95 % confidence interval) with older age (1.05, 1.05-1.05), longer transport times (1.23, 1.20-1.25), altered consciousness (increasing odds ratios from 3.12 to 4.54 with worsening AVPU scores), high reported pain scores (1.24, 1.21-1.27 relative to low/medium pain), advanced life support transports (1.81, 1.74-1.88), tachycardia (1.11, 1.06-1.16), tachypnea (1.45, 1.37-1.52), bradypnea (1.15, 1.05-1.26). Hypotension was negatively associated with SMR (0.59, 0.54-0.65). Pedestrian and non-traffic MVCs were positively associated with SMR; mechanisms of falls, penetration with sharp objects, and environmental injuries were negatively associated with SMR.
Conclusions:
We identified multiple factors associated with SMR use. These findings provide an opportunity to evaluate practices, track changes, and assess the impact of updated SMR guidelines in pediatric EMS.
