Achieving a neutral cervical spine position in suspected spinal cord injury in children: Analysing the use of a thoracic elevation device for imaging the cervical spine in paediatric patients

Pandie, Zaahid, Shepherd, Mike, Lamont, Tony, Walsh, Mark, Phillips, Mark and Page, Colin (2010) Achieving a neutral cervical spine position in suspected spinal cord injury in children: Analysing the use of a thoracic elevation device for imaging the cervical spine in paediatric patients. Emergency Medicine Journal, 27 8: 573-576. doi:10.1136/emj.2009.074575


Author Pandie, Zaahid
Shepherd, Mike
Lamont, Tony
Walsh, Mark
Phillips, Mark
Page, Colin
Title Achieving a neutral cervical spine position in suspected spinal cord injury in children: Analysing the use of a thoracic elevation device for imaging the cervical spine in paediatric patients
Journal name Emergency Medicine Journal   Check publisher's open access policy
ISSN 1472-0205
1472-0213
Publication date 2010-08
Sub-type Article (original research)
DOI 10.1136/emj.2009.074575
Volume 27
Issue 8
Start page 573
End page 576
Total pages 4
Place of publication London, U.K.
Publisher BMJ Group
Collection year 2011
Language eng
Formatted abstract
Background Paediatric patients with suspected cervical spine injury (CSI) are routinely immobilised on a firm surface using a hard collar, which results in excessive flexion of the cervical spine due to the relatively large size of the occiput. The objective of this study was to determine whether the use of a thoracic elevation device (TED) results in a more neutral cervical spine position and reduces the occurrence of cervical spine hyperflexion.

Methods
A prospective cohort study was conducted at two Emergency Departments (sites A and B) from January 2006 to May 2007. Children ≤10 years of age with suspected CSI requiring cervical imaging were included. Those at site A received a wedge-shaped TED and those at site B did not. x-Rays from both sites were analysed for flexion, extension or neutrality of the cervical spine as defined by the Cobb angle.

Results
A total of 76 patients were identified at site A and site B. There were four exclusions at each site for poor quality images. 51 patients in the site A group were found to be in neutral position (71%), compared to 29 patients in the site B group (43%) (p=0.001). One patient (1%) who had a TED was found to be hyperflexed (>10 degrees), whereas 12 (18%) patients at site B were hyperflexed (p=0.001).

Conclusions
The use of a TED appears to produce a greater proportion of neutral cervical spine films in children ≤10 years of age presenting for suspected CSI.

Keyword Cervical spinal cord injury
Childhood injury
Major clinical study
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Medicine Publications
 
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Created: Sun, 22 Aug 2010, 00:09:25 EST