Accuracy of visual determination of neutral position of the immobilized pediatric cervical spine.
BACKGROUND
The definition of neutral position for the immobilized pediatric cervical spine is not well standardized. In this study, we attempted to determine whether 1) physicians and/or paramedics could accurately assess visually if the cervical spine was in a neutral position, 2) the visual assessments of the observers were in agreement, and 3) a radiographic Cobb angle would correlate with the visual determination.


METHODS
Children presenting to a pediatric emergency department (ED) in full spinal immobilization were randomly selected (convenience sample) for this prospective study. The emergency physician and transporting paramedic independently determined positioning of the cervical spine. A radiologist, blinded to clinical information, determined Cobb angles from radiographs of the immobilized cervical spines.


RESULTS
Of the 59 children studied, the evaluation of cervical spine position by the physician and paramedic correlated in 88% of the cases. For the 22 children with non-neutral Cobb angles (definition of neutral: between 5 degrees flexion and 5 degrees extension), observers agreed in 100% of the cases. However, in 21 of these cases (95%) the position was observed as neutral.


CONCLUSIONS
Although visual determinations of neutral position of the cervical spine by two observers may correlate, radiographic studies demonstrate that neutral position was not achieved in 37% of the cases.
The College of Medicine and Public Health, The Ohio State University, Columbus, USA.
H B
HB
Boswell
A
A
Dietrich
W E
WE
Shiels
D
D
King
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M
Ginn-Pease
M J
MJ
Bowman
W H
WH
Cotton
D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D001265:Athletic Injuries / Q000150:complications; D001642:Bicycling / Q000293:injuries; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards*; D004634:Emergency Medical Technicians; D004638:Emergency Treatment / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D007103:Immobilization; D007223:Infant; D008297:Male; D008505:Medical Staff, Hospital; D015588:Observer Variation; D010808:Physical Examination / Q000379:methods / Q000592:standards*; D011187:Posture; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D016037:Single-Blind Method