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

Caleb E. Ward, Division of Emergency Medicine, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Children's National Hospital, Washington, District of Columbia.
Lorin R. Browne, Departments of Pediatrics and Emergency Medicine, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, Wisconsin.
Alexander J. Rogers, Departments of Emergency Medicine and Pediatrics, University of Michigan, CS Mott Children's Hospital, Ann Arbor, Michigan.
Monica Harding, Division of Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
Lawrence J. Cook, Division of Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
Robert E. Sapien, Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
Kathleen M. Adelgais, Section of Pediatric Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Colorado Children's Hospital, Aurora, Colorado.
Leah Tzimenatos, Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, California.
Fahd A. Ahmad, Division of Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, St Louis, Missouri.
Sylvia Owusu-Ansah, Division of Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Julie C. Leonard, Division of Emergency Medicine, Department of Pediatrics, Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio.

Document Type

Journal Article

Publication Date

3-12-2025

Journal

Prehospital emergency care

DOI

10.1080/10903127.2025.2472269

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.

Department

Pediatrics

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