Development of a New Emergency Medicine Spinal Immobilization Protocol for Pediatric Trauma Patients and First Applicability Test on Emergency Medicine Personnel

Abstract

Objectives:The purpose of this study was to (i) develop a protocol that supports decision making for prehospital spinal immobilization in pediatric trauma patients based on evidence from current scientific literature and (ii) perform an applicability test on emergency medicine personnel.Methods: A structured search of the literature published between 1980 and 2019 was performed in MEDLINE using PubMed. Based on this literature search, a new Emergency Medicine Spinal Immobilization Protocol for pediatric trauma patients (E.M.S. IMMO Protocol Pediatric) was developed. Parameters found in the literature, such as trauma mechanism and clinical findings that accounted for a high probability of spinal injury, were included in the protocol. An applicability test was administered to German emergency medicine personnel using a questionnaire with case examples to assess correct decision making according to the protocol.Results: The E.M.S. IMMO Protocol Pediatric was developed based on evidence from published literature. In the applicability test involving 44 emergency medicine providers revealed that 82.9% of participants chose the correct type of immobilization based on the protocol. A total of 97.8% evaluated the E.M.S. IMMO Protocol Pediatric as helpful.Conclusions: Based on the current literature, the E.M.S. IMMO Protocol Pediatric was developed in accordance with established procedures used in trauma care. The decision regarding immobilization is made on based on the cardiopulmonary status of the patient, and life-threatening injuries are treated with priority. If the patient presents in stable condition, the necessity for full immobilization is assessed based upon the mechanisms of injury, assessment of impairment, and clinical examination.

Adaptation and validation of a pediatric simulator to study the movement of the cervical spine

“…Survey results, such as those by Khetarpal et al [29], conclude that even within the same state, recommendations for spinal clearance and pediatric immobilization are discrepant. In 2022, Nolte et al [30] developed a new and interesting Emergency Medicine Spinal Immobilization Protocol for pediatric trauma patients. It was evaluated and shown to have a high level of compliance among professionals who performed the applicability test (82.9%), and a very high rate of professionals considered the protocol useful (97.8%) as well [30].…”

“…In 2022, Nolte et al [30] developed a new and interesting Emergency Medicine Spinal Immobilization Protocol for pediatric trauma patients. It was evaluated and shown to have a high level of compliance among professionals who performed the applicability test (82.9%), and a very high rate of professionals considered the protocol useful (97.8%) as well [30]. However, it should be noted that these professionals constituted a small group (44 partic-ipants) from the same location (Germany), so further research is needed to consider this protocol as applicable to broader trauma healthcare.…”