Potential adverse effects of spinal immobilization in children.
OBJECTIVE
The purpose of our study was to describe potential adverse effects associated with spinal immobilization following trauma among children.


METHODS
We conducted a prospective cohort study of children presenting to the emergency department (ED) for evaluation following trauma over a 13-month period. Children were eligible if they underwent spinal immobilization prior to physician evaluation or if they met the American College of Surgeons (ACS) guidelines for spinal immobilization but were not immobilized. We compared children who were immobilized with those who were not immobilized for self-reported pain, use of radiography to evaluate the cervical spine, ED length of stay, and ED disposition. We also report the characteristics of the cohort.


RESULTS
One hundred seventy-three spine-immobilized children and 112 children who met ACS criteria but were not immobilized were enrolled. There were differences between the two study groups, which included age, mechanism of injury, and proportion transported by emergency medical services. However, the comparison groups had comparable Pediatric Trauma Scores (PTSs) and Glasgow Coma Scale scores (GCSs). Immobilized children had a higher median pain score (3 versus 2) and were more likely to undergo cervical radiography (56.6% versus 13.4%) and be admitted to the hospital (41.6% versus 14.3%). The comparison groups had similar lengths of stay in the ED.


CONCLUSIONS
Despite presenting with comparable PTSs and GCSs, children who underwent spinal immobilization following trauma had a higher degree of self-reported pain, and were much more likely to undergo radiographic cervical spine clearance and be admitted to the hospital than those who were not immobilized. Future studies are warranted to determine whether these differences are related to spinal immobilization or differences in the mechanisms of injury, injury patterns, or other variables.
Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri 63110, USA. leonard_ju@kids.wustl.edu
Julie C
JC
Leonard
Jingnan
J
Mao
David M
DM
Jaffe
D000293:Adolescent; D000704:Analysis of Variance; D002574:Cervical Vertebrae / Q000293:injuries*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007103:Immobilization / Q000009:adverse effects*; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010147:Pain Measurement; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013124:Spinal Injuries / Q000628:therapy*; D015599:Trauma Severity Indices; D014861:Washington