Hewes Hilary A, Ravindra Vijay M, Ryan Sydney, Russell Katie W, Soisson Sean, Brockmeyer Douglas L
From the Division of Pediatric Emergency Medicine, Department of Pediatrics.
Division of Pediatric Surgery, Department of Surgery, School of Medicine.
Pediatr Emerg Care. 2023 Apr 1;39(4):274-278. doi: 10.1097/PEC.0000000000002755. Epub 2022 May 26.
After evaluation and treatment of minor traumatic cervical spine injury (CSI), many children are discharged home in a rigid cervical orthosis (RCO). This study investigated their adherence to RCO treatment recommendations. The feasibility of telehealth cervical spine clearance was also explored.
This was a prospective observational study of children 3 to 18 years old with mild CSI evaluated at a level I pediatric trauma center from December 1, 2019, through July 31, 2021. Before emergency department discharge, patients received RCO use instructions and recommendation for follow-up with in-person neurosurgery clinic visit, neurosurgery telehealth visit, or in-person primary care provider visit. The family was responsible for arranging follow-up. Primary outcomes included compliance with follow-up and collar use.
Ninety-eight children (mean age, 11.3 ± 4.1 years) were included. Overall, follow-up contact was available for 51 patients (52%). At 1-week follow-up with 36 children, 64% were collar compliant, 13 had no pain (38% remained in RCO), 14 had mild pain without limitations, 8 had pain with some limitations, and 1 had significant pain. At 2-week follow-up with 31 children, 9 (29%) were collar compliant, 23 had no pain, 7 had mild pain without limitations, and 1 with significant persistent pain was found to have an odontoid fracture requiring C1-2 fusion. Patients/families often discontinued the use of the collar without follow-up (47%). Approximately half utilized a recommended clinical follow-up option for clearance, most often in neurosurgery clinic or using a neurosurgery telehealth visit. The mean time to follow-up was 11.34 ± 4.9 days (range, 3-25 days), and mean collar compliance lasted 9.8 ± 5.7 days (range, 1-25 days). No child experienced any short-term complications related to RCO use.
In this pilot study, a substantial portion of children with mild CSIs discharged from the emergency department with an RCO did not adhere to compliance or follow-up recommendations. Persistent pain requires further evaluation.
在对轻度创伤性颈椎损伤（CSI）进行评估和治疗后，许多儿童戴着硬质颈托（RCO）出院回家。本研究调查了他们对RCO治疗建议的依从性。还探讨了远程医疗颈椎检查的可行性。
这是一项对2019年12月1日至2021年7月31日在一级儿科创伤中心接受评估的3至18岁轻度CSI儿童进行的前瞻性观察研究。在急诊科出院前，患者收到了RCO使用说明以及关于随访的建议，随访方式包括亲自到神经外科门诊就诊、神经外科远程医疗就诊或亲自到初级保健提供者处就诊。家庭负责安排随访。主要结局包括随访依从性和颈托使用情况。
纳入了98名儿童（平均年龄11.3±4.1岁）。总体而言，51名患者（52%）获得了随访联系。在对36名儿童进行的1周随访中，64%的儿童依从颈托使用，13名儿童无疼痛（38%仍佩戴RCO），14名儿童有轻度疼痛但无活动受限，8名儿童有疼痛且有一定活动受限，1名儿童有明显疼痛。在对31名儿童进行的2周随访中，9名（29%）儿童依从颈托使用，23名儿童无疼痛，7名儿童有轻度疼痛但无活动受限，1名有明显持续性疼痛的儿童被发现齿突骨折，需要进行C1 - 2融合。患者/家庭经常在未进行随访的情况下就停止使用颈托（47%）。大约一半的患者采用了推荐的临床随访检查方式，最常见的是在神经外科门诊或通过神经外科远程医疗就诊。随访的平均时间为11.34±4.9天（范围3 - 25天），颈托的平均依从使用时间为9.8±5.7天（范围1 - 25天）。没有儿童经历与RCO使用相关的任何短期并发症。
在这项试点研究中，很大一部分戴着RCO从急诊科出院的轻度CSI儿童未遵守依从性或随访建议。持续性疼痛需要进一步评估。
