التفاصيل البيبلوغرافية
| العنوان: |
Prehospital Factors Associated With Cervical Spine Injury in Pediatric Blunt Trauma Patients. |
| المؤلفون: |
Browne, Lorin R., Ahmad, Fahd A., Schwartz, Hamilton, Wallendorf, Michael, Kuppermann, Nathan, Lerner, E. Brooke, Leonard, Julie C., Alpern, Elizabeth |
| المصدر: |
Academic Emergency Medicine; May2021, Vol. 28 Issue 5, p553-561, 9p |
| مصطلحات موضوعية: |
CERVICAL vertebrae, PHYSICAL diagnosis, PILOT projects, STATISTICS, SPINAL cord injuries, BLUNT trauma, SCIENTIFIC observation, CONFIDENCE intervals, PATIENTS, TRANSPORTATION of patients, EMERGENCY medical services, DESCRIPTIVE statistics, PSYCHOSOCIAL factors, ODDS ratio, EMERGENCY medicine, LONGITUDINAL method, DISEASE risk factors, CHILDREN |
| مستخلص: |
Background: The risk for cervical spine injury (CSI) must be assessed in children who sustain blunt trauma. The Pediatric Emergency Care Applied Research Network (PECARN) retrospectively derived CSI model identifies CSI risk in children based on emergency department (ED) provider observations. The objective of this pilot study was to determine the univariate association of emergency medical services (EMS) provider‐observed historical, mechanistic, and physical examination factors with CSI in injured children. Secondarily, we assessed the performance of the previously identified eight PECARN CSI risk factors (PECARN model) based exclusively on EMS provider observation. Methods: We conducted a four‐center, prospective observational study of children 0 to 17 years old who were transported by EMS after blunt trauma and underwent spinal motion restriction or trauma team activation in the ED. In the ED, EMS providers recorded their observations for a priori determined CSI risk factors. CSIs were classified by reviewing imaging, consultations, and/or telephone follow‐up. We calculated bivariable relative risks and test characteristics for the PECARN model based solely on EMS provider observations. Results: Of 1,372 enrolled children, 25 (1.8%) had CSIs. Of the a priori determined CSI risk factors, seven factors had bivariable associations with CSIs: axial load, altered mental status, signs of basilar skull fracture, substantial torso injury, substantial thoracic injury, respiratory distress, and decreased oxygen saturation. The PECARN model (high‐risk motor vehicle collision, diving mechanism, predisposing condition, neck pain, decreased neck mobility, altered mental status, neurologic deficits, and/or substantial torso injury) exhibited the following test characteristics when based on EMS provider observations: sensitivity = 96.0% (95% confidence interval [CI] = 88.3% to 100.0%); negative predictive value = 99.8% (95% CI = 99.4% to 100.0%); specificity = 38.5% (95% CI = 35.9% to 41.1%); and positive predictive value = 2.8% (95% CI = 1.7% to 3.9%). Conclusion: EMS providers can identify risk factors associated with CSI in injured children who experience blunt trauma. These risk factors may be considered for inclusion in a pediatric CSI decision rule specific to the prehospital setting. [ABSTRACT FROM AUTHOR] |
|
Copyright of Academic Emergency Medicine is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) |
| قاعدة البيانات: |
Complementary Index |
Full Text Finder