Accuracy of visual determination of neutral position of the immobilized pediatric cervical spine

Citation
Hb. Boswell et al., Accuracy of visual determination of neutral position of the immobilized pediatric cervical spine, PEDIAT EMER, 17(1), 2001, pp. 10-14
Citations number
9
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Pediatrics
Journal title
PEDIATRIC EMERGENCY CARE
ISSN journal
0749-5161 → ACNP
Volume
17
Issue
1
Year of publication
2001
Pages
10 - 14
Database
ISI
SICI code
0749-5161(200102)17:1<10:AOVDON>2.0.ZU;2-W
Abstract
Background: The definition of neutral position for the immobilized pediatri c cervical spine is not well standardized. In this study, we attempted to d etermine whether 1) physicians and/or paramedics could accurately assess vi sually if the cervical spine was in a neutral position, 2) the visual asses sments of the observers were in agreement, and 3) a radiographic Cobb angle would correlate with the visual determination. Methods: Children presenting to a pediatric emergency department (ED) in fu ll spinal immobilization were randomly selected (convenience sample) for th is prospective study. The emergency physician and transporting paramedic in dependently determined positioning of the cervical spine. A radiologist, bl inded to clinical information, determined Cobb angles from radiographs of t he immobilized cervical spines. Results: Of the 59 children studied, the evaluation of cervical spine posit ion by the physician and paramedic correlated in 88% of the cases. For the 22 children with non-neutral Cobb angles (definition of neutral: between 5 degrees flexion and 5 degrees extension), observers agreed in 100% of the c ases. However, in 21 of these cases (95%) the position was observed as neut ral. Conclusions: Although visual determinations of neutral position of the cerv ical spine by two observers may correlate, radiographic studies demonstrate that neutral position was not achieved in 37% of the cases.