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
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.