Related Experiment Videos
Neutral cervical spine positioning in children
1Division of Pediatric Emergency Medicine, Henry Ford Hospital, Detroit, Michigan.
Insights
Children under 8 years old need back elevation for neutral spine positioning on backboards. Two observers reliably agreed on the necessary height for this neutral position.
Area of Science:
- Pediatric Emergency Medicine
- Orthopedic Biomechanics
- Clinical Assessment
Background:
- Proper cervical spine alignment is crucial in pediatric patients, especially those under 8 years old.
- Supine positioning on backboards can alter cervical spine alignment in young children.
- Determining optimal positioning aids is essential for preventing secondary injuries.
Purpose of the Study:
- To ascertain the required back elevation height for neutral cervical spine positioning in children under 8 years old.
- To evaluate inter-observer agreement on achieving neutral cervical spine alignment.
Main Methods:
- Prospective study conducted in pediatric emergency and outpatient settings.
- Convenience sample of children under 8 years old.
- Two independent observers utilized standardized padding and shims to achieve neutral spine positioning.
Main Results:
- All participants required back elevation, with a mean height of 25.4 mm (range: 5-41 mm).
- Younger children (<4 years) needed significantly more elevation than older children (≥4 years).
- High inter-observer agreement was observed (kappa = 0.56).
Conclusions:
- Children under 8 years old necessitate back elevation for neutral supine positioning on backboards.
- Independent observers demonstrated reliable agreement in identifying neutral cervical spine alignment in this age group.
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.