Factors associated with cervical spine injury in children after blunt trauma.

STUDY OBJECTIVE: Cervical spine injuries in children are rare. However, immobilization and imaging for potential cervical spine injury after trauma are common and are associated with adverse effects. Risk factors for cervical spine injury have been developed to safely limit immobilization and radiography in adults, but not in children. The purpose of our study is to identify risk factors associated with cervical spine injury in children after blunt trauma. METHODS: We conducted a case-control study of children younger than 16 years, presenting after blunt trauma, and who received cervical spine radiographs at 17 hospitals in the Pediatric Emergency Care Applied Research Network (PECARN) between January 2000 and December 2004. Cases were children with cervical spine injury. We created 3 control groups of children free of cervical spine injury: (1) random controls, (2) age and mechanism of injury-matched controls, and (3) for cases receiving out-of-hospital emergency medical services (EMS), age-matched controls who also received EMS care. We abstracted data from 3 sources: PECARN hospital, referring hospital, and out-of-hospital patient records. We performed multiple logistic regression analyses to identify predictors of cervical spine injury and calculated the model's sensitivity and specificity. RESULTS: We reviewed 540 records of children with cervical spine injury and 1,060, 1,012, and 702 random, mechanism of injury, and EMS controls, respectively. In the analysis using random controls, we identified 8 factors associated with cervical spine injury: altered mental status, focal neurologic findings, neck pain, torticollis, substantial torso injury, conditions predisposing to cervical spine injury, diving, and high-risk motor vehicle crash. Having 1 or more factors was 98% (95% confidence interval 96% to 99%) sensitive and 26% (95% confidence interval 23% to 29%) specific for cervical spine injury. We identified similar risk factors in the other analyses. CONCLUSION: We identified an 8-variable model for cervical spine injury in children after blunt trauma that warrants prospective refinement and validation.

Simulation Training to Maintain Neonatal Resuscitation and Pediatric Sedation Skills for Emergency Medicine Faculty.

BACKGROUND: Neonatal resuscitations and significant adverse cardiorespiratory events during pediatric sedations are infrequent. Thus, it is challenging to maintain the skills necessary to manage patients experiencing these events. As the pediatric emergency medicine specialty expands, exposure of general emergency medicine physicians to these potentially critical patients may become even more limited. As such, effective training strategies need to be developed. Simulation provides the opportunity to experience a rare event in a safe learning environment, and has shown efficacy in skill acquisition for medical students and residents. Less is known regarding its use for faculty-level learners. OBJECTIVES: To assess the acceptability, efficacy, and feasibility of a simulation-based educational intervention for emergency medicine faculty on their knowledge, comfort, and perceived competence in neonatal resuscitation and pediatric sedation skills. METHODS: Eighteen academic emergency medicine faculty participated in a 4-hour educational intervention with high-fidelity simulation sessions focused on neonatal resuscitation (precipitous delivery of a depressed newborn) and adverse events associated with pediatric sedation (laryngospasm and hypoventilation). Faculty also practiced umbilical vein catheterization, video laryngoscopy skills, and reviewed supplies stocked in our pediatric resuscitation cart. A pre- and postintervention evaluation was completed consisting of knowledge and attitude questions. Paired t test analysis was used to detect statistically significant change (P ≤ 0.05). RESULTS: Results were obtained from 17 faculty members. Simulation training was well accepted pre- and postintervention, and simulation was effective with statistically significant improvement in both knowledge and attitude. This type of event was feasible with 83% of emergency medicine faculty participating. CONCLUSION: Emergency medicine faculty have limited opportunities to manage neonatal resuscitations and adverse events in pediatric sedations. Simulation training appears to be an effective educational modality to help maintain these important skills.