Errors in cervical spine immobilization during pediatric trauma evaluation.

Autor: Ahmed OZ; Division of Trauma and Burn Surgery, Department of General and Thoracic Surgery, Children's National Medical Center, Washington, Dist. of Columbia., Webman RB; Division of Trauma and Burn Surgery, Department of General and Thoracic Surgery, Children's National Medical Center, Washington, Dist. of Columbia., Sheth PD; Division of Trauma and Burn Surgery, Department of General and Thoracic Surgery, Children's National Medical Center, Washington, Dist. of Columbia., Donnenfield JI; Division of Trauma and Burn Surgery, Department of General and Thoracic Surgery, Children's National Medical Center, Washington, Dist. of Columbia., Yang J; Division of Trauma and Burn Surgery, Department of General and Thoracic Surgery, Children's National Medical Center, Washington, Dist. of Columbia., Sarcevic A; College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania., Marsic I; Department of Electrical and Computer Engineering, Rutgers University, Piscataway, New Jersey., Burd RS; Division of Trauma and Burn Surgery, Department of General and Thoracic Surgery, Children's National Medical Center, Washington, Dist. of Columbia. Electronic address: rburd@cnmc.org.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2018 Aug; Vol. 228, pp. 135-141. Date of Electronic Publication: 2018 Apr 25.
DOI: 10.1016/j.jss.2018.02.023
Abstrakt: Background: The purpose of this study was to identify factors during trauma evaluation that increase the likelihood of errors in cervical spine immobilization ('lapses').
Materials and Methods: Multivariate analysis was used to identify the associations between patient characteristics, event features, and tasks performed in proximity to the head and neck and the occurrence and duration of a lapse in maintaining cervical spine immobilization during 56 pediatric trauma evaluations.
Results: Lapses in cervical spine immobilization occurred in 71.4% of patients (n = 40), with an average of 1.2 ± 1.3 lapses per patient. Head and neck tasks classified as oxygen manipulation occurred an average of 12.2 ± 9.7 times per patient, whereas those related to neck examination and cervical collar manipulation occurred an average of 2.7 ± 1.7 and 2.1 ± 1.2 times per patient, respectively. More oxygen-related tasks were performed among patients who had than those who did not have a lapse (27.3 ± 16.5 versus 11.5 ± 8.0 tasks, P = 0.001). Patients who had cervical collar placement or manipulation had a two-fold higher risk of a lapse than those who did not have these tasks performed (OR 1.92, 95% CI 0.56, 3.28, P = 0.006). More lapses occurred during evaluations on the weekend (P = 0.01), when more tasks related to supplemental oxygen manipulation were performed (P = 0.02) and when more tasks associated with cervical collar management were performed (P < 0.001).
Conclusions: Errors in cervical spine immobilization were frequently observed during the initial evaluation of injured children. Strategies to reduce these errors should target approaches to head and neck management during the primary and secondary phases of trauma evaluation.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: