Pediatric emergency medicine trisk 3579 3579
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Several concepts should be kept in mind concerning cervical immobilization in
children. It has been estimated that 3% to 25% of spinal cord injuries occur during
transit or early in the course of management, although a 2001 Cochrane report
noted that there are no randomized controlled studies on the effect of
immobilization on mortality, neurologic injury, spinal stability, and other adverse
effects. It is also important to realize that as many as 20% of spinal injuries
involve noncontiguous vertebral elements, so entire spinal column immobilization
and evaluation are imperative. Currently, the Congress of Neurological Surgeons
recommends a cervical collar and backboard immobilization in the setting of
nonnegligible risk of injury after trauma. Soft cervical collars offer no protection
to an unstable spine, and hard collars alone may allow a fair amount of flexion,
extension, and lateral movement of the cervical spine. Ideal immobilization
involves a hard cervical collar in conjunction with a full spine board, soft spacing
devices, and securing straps ( Fig. 112.10 ). Hard collars, including the C-Breeze
and XTW (DeRoyal Industries, Inc. Powell, TN), Miami J (Jerome Medical,
Moorestown, NJ), Philadelphia (Philadelphia Collar Company, Thorofare, NJ),
Stifneck (Laerdal, Stavanger, Norway), and Aspen (Medical Products, Long
Beach, CA), are effective in restricting most of the range of motion in the cervical
spine. Miami J collars have been associated with lower levels of mandibular and
ocular pressures, reducing the risk of occipital pressure ulcers while maintaining
appropriate immobilization.
