 |
|
Removing the Pediatric Cervical Collar
Current Practice Patterns
Hisham A. Omran, MD;
M. Denise Dowd, MD, MPH;
Jane F. Knapp, MD
Arch Pediatr Adolesc Med. 2001;155:162-166.
Objectives To identify the current practice patterns of emergency medicine practitioners
and the typical criteria used in discontinuing cervical spine immobilization
(CSI) in the pediatric patient.
Design Mail-in survey.
Participants All physicians on the mailing list of the American Academy of Pediatrics
Section of Emergency Medicine and an equal number of randomly chosen members
of the American College of Emergency Physicians. The total number of participants
was 1360.
Methods The survey consisted of a case scenario describing a 3-year-old child
brought to the emergency department with CSI. The approach to such a scenario
was assessed. Surveys were mailed with self-addressed stamped envelopes; repeat
mailings were sent at 4 and 8 weeks after the first mailing. Those not currently
in active practice or not involved in the decision to discontinue CSI were
excluded from the study.
Results The response rate was 55%. Most respondents were younger than 44 years
(71%), in practice less than 10 years (56%), and practiced in an urban setting
(68%). Nearly two thirds (62.6%) had completed residency training in pediatrics,
24% in emergency medicine and 36% a pediatric emergency medicine fellowship.
Most (63%) would discontinue CSI without obtaining radiographs. Factors associated
with removal were residency training in pediatrics and being in practice for
less than 10 years. The most common criteria for discontinuing CSI were normal
neurological (96%) and cervical spine (98%) examinations, normal mental status
(92%), and absence of neck pain (93%).
Conclusions Discontinuing CSI without obtaining radiographs is common, especially
among those with residency training in pediatrics and those in practice for
less than 10 years. Knowledge of current practice is essential to future development
of guidelines for managing pediatric trauma patients for whom cervical spine
injury is a consideration.
From the Division of Emergency Medicine, Children's Mercy Hospital,
University of Missouri, Kansas City.
Corresponding author and reprints: Hisham A. Omran, MD, Division
of Emergency Medicine, St Christopher's Hospital for Children, Erie Avenue
at Front Street, Philadelphia, PA 19134 (e-mail: Hisham_omran{at}hotmail.com).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Should We Keep Collars on Kids?
JWatch Emergency Med. 2001;2001:4-4.
FULL TEXT
|
