Prevalence and Indications for Applying Prehospital Spinal Motion Restriction in Children at Risk for Cervical Spine...

Area of Science:

• Emergency Medicine
• Pediatric Trauma
• Clinical Prediction Rules

Background:

• Spinal motion restriction (SMR) is frequently used for pediatric blunt trauma patients with potential cervical spine injuries (CSI).
• Risks associated with indiscriminate SMR application necessitate understanding current emergency medical services (EMS) practices.
• The Pediatric Emergency Care Applied Research Network (PECARN) CSI clinical prediction rule was recently developed.

Purpose of the Study:

• To determine the prevalence of prehospital SMR application in children with blunt trauma.
• To identify factors associated with SMR placement by EMS.

Main Methods:

• Secondary analysis of a prospective study involving children (0-17 years) with blunt trauma transported by EMS.
• Prehospital clinician surveys collected data on CSI risk factors and SMR application.
• Univariable and multivariable logistic regression analyzed factors associated with SMR placement.

Main Results:

• Of 7,721 children, 41.5% received SMR, while only 1.6% had confirmed CSI.
• SMR prevalence increased with age, from 22.0% in children <2 years to 35.5-50.4% in older children.
• Factors associated with SMR included demographics, high-risk mechanisms (e.g., MVC, falls), clinical history (e.g., LOC, neck pain), and exam findings (e.g., altered mental status, neck tenderness).

Conclusions:

• A significant discrepancy exists between the high rate of SMR application (41.5%) and the low incidence of CSI (1.6%) in pediatric blunt trauma patients.
• Many factors influencing prehospital SMR decisions are not included in the current PECARN CSI prediction rule.
• Implementation of a risk-centered EMS decision aid is needed to address these disparities in SMR use for children.