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Neutral cervical spine positioning in children
1Division of Pediatric Emergency Medicine, Henry Ford Hospital, Detroit, Michigan.
Study Objectives:
To determine the height of back elevation required to place the cervical spine of children less than 8 years old in neutral position and whether agreement on the height required for neutral position could be reached by two independent observers.
Study Design:
Prospective.
Setting:
Pediatric emergency department and outpatient clinics.
Type Of Participants:
Convenience sample of children less than 8 years old.
Interventions:
Independent placement of children in neutral position by two observers using standard sized padding with or without shims to raise the back off a backboard.
Measurements And Results:
All children required elevation of the back for correct neutral position (mean height, 25.4 +/- 6.7 mm; range, 5 to 41 mm). Children less than 4 years old required more elevation than those > or = 4 years old (27 +/- 7.2 vs 22 +/- 4.2 mm, P < .05). Independent observer measurements were similar (mean, 25 +/- 8.0 vs 25.7 +/- 6.8 mm; interobserver kappa = .56).
Conclusion:
Children less than 8 years old require back elevation to achieve neutral position while lying supine on a backboard. Also, independent observers can agree on what constitutes neutral position in most children.