Application of cervical spinal motion restriction to injured children in the prehospital setting

Authors

Sriram Ramgopal, Division 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. Electronic address: sramgopal@luriechildrens.org.
Caleb E. Ward, Division of Emergency Medicine, Children's National Hospital; The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America.
Alexander Rogers, Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America.
Seth D. Goldstein, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
Julie C. Leonard, Division of Emergency Medicine, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, United States of America.
Christian Martin-Gill, Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.

Document Type

Journal Article

Publication Date

2-4-2025

Journal

The American journal of emergency medicine

Volume

90

DOI

10.1016/j.ajem.2025.02.006

Keywords

Cervical collar use; Cervical spine injury; Emergency medical services; Immobilization protocols; Injury mechanisms; Pediatric EMS guidelines; Pediatric trauma; Prehospital care; Spinal motion restriction; Trauma transport

Abstract

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.

APA Citation

Ramgopal, Sriram; Ward, Caleb E.; Rogers, Alexander; Goldstein, Seth D.; Leonard, Julie C.; and Martin-Gill, Christian, "Application of cervical spinal motion restriction to injured children in the prehospital setting" (2025). GW Authored Works. Paper 6625.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6625

Department

Pediatrics