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

Abstract

Objectives: Spinal motion restriction (SMR) is commonly applied to injured children with potential cervical spine injuries (CSI). There are, however, risks to indiscriminate SMR application. We recently derived the Pediatric Emergency Care Applied Research Network (PECARN) CSI clinical prediction rule. Effective implementation of this prediction rule requires an accurate understanding of current emergency medical services (EMS) SMR practices. Little is known about the prevalence of prehospital SMR application in children. Our primary objective was to determine the proportion of children sustaining blunt trauma who are placed in SMR by EMS. Our secondary objective was to identify factors associated with SMR placement.

Methods: We conducted a secondary analysis of data collected during a prospective study of children 0-17 years with blunt trauma transported by EMS to one of 18 PECARN-affiliated emergency departments. Prehospital clinicians completed surveys regarding CSI risk factors and SMR application. We summarized SMR prevalence, techniques used, reasons for application, and clinician suspicion for CSI by patient age. We conducted univariable and multivariable logistic regression to determine factors associated with SMR placement.

Results: Of 13,453 children transported by EMS, we enrolled a convenience sample of 7,721 (57.4%) of whom 1.6% had a CSI and 41.5% had SMR placed. Older children were more likely to have SMR placed (35.5-50.4%) compared to those < 2 years (22.0%). Factors associated with SMR placement included patient demographics (non-Hispanic White race/ethnicity, age >2 years), mechanisms of injury (high-risk motor vehicle crash (MVC), unrestrained MVC passenger, high-risk fall, axial load), clinical history (loss of consciousness, self-reported neck pain, paresthesia, numbness, or extremity weakness) and physical examination findings (altered mental status, neck tenderness, inability to move neck, focal neurological deficits, and substantial head or torso injuries).

Conclusions: Of children transported by EMS after blunt trauma in this study, 41.5% had SMR placed, while only 1.6% had CSIs. Factors associated with SMR placement included patient demographics, mechanism of injury, history, and examination findings. Many of these factors are not in the new PECARN CSI clinical prediction rule. Implementation of a risk-centered EMS decision aid for SMR in children after blunt trauma must address this discrepancy.