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Background <p>Prehospital spinal immobilization in pediatric trauma patients, particularly of the cervical spine, remains highly controversial. Although decision rules aim to guide emergency teams, uncertainty about their clinical application persists.</p> Objective <p>The objectives of this study were (i)&#xa0;to perform a&#xa0;critical evaluation of existing pediatric spinal immobilization protocols, (ii)&#xa0;to develop a&#xa0;pragmatic approach to cervical spine stabilization, and (iii)&#xa0;to implement this approach in the most practical manner possible.</p> Materials and methods <p>A&#xa0;structured literature review identified and compared established pediatric immobilization protocols (Pediatric Emergency Care Applied Research Network [PECARN] rules, PEDSPINE trial protocols, National Emergency X‑Radiography Utilization Study [NEXUS] criteria, Canadian C‑Spine Rule [CCSR]). Subsequently, the clinical applicability of these protocols was examined through three case vignettes, focusing on clinical decision rules, cervical spine immobilization, and pediatric traumatic fixed torticollis.</p> Results <p>Spinal immobilization is time consuming and may cause harm to the patient. Therefore, it is essential that emergency teams follow the xABCDE approach (<i>xABCDE</i>:&#xa0;<i>x</i>&#xa0;exsanguination, <i>A</i>&#xa0;airway, <i>B</i>&#xa0;breathing, <i>C</i>&#xa0;circulation, <i>D</i>&#xa0;disability, <i>E</i>&#xa0;environment), carefully weighing the need for spinal motion restriction on a&#xa0;case-by-case basis. To achieve a&#xa0;neutral cervical spine position in pediatric patients &lt; 8&#xa0;years, elevation of the shoulders using a&#xa0;neck roll (thoracic elevation device) is required. For transport, vacuum mattresses and head blocks appear practical and effective in pediatric trauma patients.</p> Conclusion <p>Currently, there is insufficient evidence to determine which clinical decision rule most accurately guides prehospital indications for spinal immobilization in children following blunt trauma. Immobilization should therefore be individualized, guided by the injury pattern and the child’s clinical status.</p>

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„Think before you immobilize!“ – prähospitale Ruhigstellung bei pädiatrischen Patienten

  • 期刊论文

  • 发表日期：

    2025年11月3日

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  • Ruth Kröss,
  • David Häske

摘要

Background

Prehospital spinal immobilization in pediatric trauma patients, particularly of the cervical spine, remains highly controversial. Although decision rules aim to guide emergency teams, uncertainty about their clinical application persists.

Objective

The objectives of this study were (i) to perform a critical evaluation of existing pediatric spinal immobilization protocols, (ii) to develop a pragmatic approach to cervical spine stabilization, and (iii) to implement this approach in the most practical manner possible.

Materials and methods

A structured literature review identified and compared established pediatric immobilization protocols (Pediatric Emergency Care Applied Research Network [PECARN] rules, PEDSPINE trial protocols, National Emergency X‑Radiography Utilization Study [NEXUS] criteria, Canadian C‑Spine Rule [CCSR]). Subsequently, the clinical applicability of these protocols was examined through three case vignettes, focusing on clinical decision rules, cervical spine immobilization, and pediatric traumatic fixed torticollis.

Results

Spinal immobilization is time consuming and may cause harm to the patient. Therefore, it is essential that emergency teams follow the xABCDE approach (xABCDE: x exsanguination, A airway, B breathing, C circulation, D disability, E environment), carefully weighing the need for spinal motion restriction on a case-by-case basis. To achieve a neutral cervical spine position in pediatric patients < 8 years, elevation of the shoulders using a neck roll (thoracic elevation device) is required. For transport, vacuum mattresses and head blocks appear practical and effective in pediatric trauma patients.

Conclusion

Currently, there is insufficient evidence to determine which clinical decision rule most accurately guides prehospital indications for spinal immobilization in children following blunt trauma. Immobilization should therefore be individualized, guided by the injury pattern and the child’s clinical status.