Ward Caleb E, Browne Lorin R, Rogers Alexander J, Harding Monica, Cook Lawrence J, Sapien Robert E, Adelgais Kathleen M, Tzimenatos Leah, Ahmad Fahd A, Owusu-Ansah Sylvia, Leonard Julie C
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.
Departments of Pediatrics and Emergency Medicine, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, Wisconsin.
Prehosp Emerg Care. 2025 Mar 12:1-10. doi: 10.1080/10903127.2025.2472269.
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.
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.
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).
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.
脊柱活动限制（SMR）通常应用于可能存在颈椎损伤（CSI）的受伤儿童。然而，不加区分地应用SMR存在风险。我们最近推导出了儿科急诊护理应用研究网络（PECARN）的CSI临床预测规则。有效实施该预测规则需要准确了解当前紧急医疗服务（EMS）的SMR实践情况。对于院前SMR在儿童中的应用 prevalence 知之甚少。我们的主要目的是确定遭受钝性创伤且被EMS置于SMR的儿童比例。我们的次要目的是识别与放置SMR相关的因素。
我们对一项前瞻性研究中收集的数据进行了二次分析，该研究涉及0至17岁因钝性创伤由EMS转运至18个与PECARN相关的急诊科之一的儿童。院前临床医生完成了关于CSI危险因素和SMR应用情况的调查。我们按患者年龄总结了SMR的 prevalence、使用的技术、应用原因以及临床医生对CSI的怀疑情况。我们进行了单变量和多变量逻辑回归分析以确定与放置SMR相关的因素。
在由EMS转运的13453名儿童中，我们纳入了一个便利样本，共7721名（57.4%），其中1.6%患有CSI，41.5%被放置了SMR。与2岁以下儿童（22.0%）相比，年龄较大的儿童更有可能被放置SMR（35.5 - 50.4%）。与放置SMR相关的因素包括患者人口统计学特征（非西班牙裔白人种族/族裔、年龄>2岁）、损伤机制（高危机动车碰撞（MVC）、未系安全带的MVC乘客、高危跌倒、轴向负荷）、临床病史（意识丧失、自述颈部疼痛、感觉异常、麻木或肢体无力）以及体格检查结果（精神状态改变、颈部压痛、无法活动颈部、局灶性神经功能缺损以及严重的头部或躯干损伤）。
在本研究中，因钝性创伤后由EMS转运的儿童中，41.5%被放置了SMR，而只有1.6%患有CSI。与放置SMR相关的因素包括患者人口统计学特征、损伤机制、病史和检查结果。这些因素中的许多并不在新的PECARN CSI临床预测规则中。针对钝性创伤后儿童的SMR实施以风险为中心的EMS决策辅助工具必须解决这一差异。
