The Fate of the Cervical Collar: An Observational Pilot Study Investigating Follow-up Care After Emergency Department Discharge in Children With Mild Traumatic Neck Injuries. Issue 4 (26th April 2023)

• Record Type: Journal Article
• Authors: Hewes, Hilary A.; Ravindra, Vijay M.; Ryan, Sydney; Russell, Katie W.; Soisson, Sean; Brockmeyer, Douglas L.
• Is Part Of: Pediatric emergency care. Volume 39:Issue 4(2023)
• Page Start: 274
• Page End: 278
• Publication Date: 2023-04-26
• Subjects: cervical spine clearance -- cervical spine injury -- telehealth -- trauma; Pediatric emergencies -- Periodicals; 618.92002505
• DOI: 10.1097/PEC.0000000000002755
• Languages: English
• ISSNs: 0749-5161

Abstract

Abstract : Objectives: After evaluation and treatment of minor traumatic cervical spine injury (CSI), many children are discharged home in a rigid cervical orthosis (RCO). This study investigated their adherence to RCO treatment recommendations. The feasibility of telehealth cervical spine clearance was also explored. Methods: This was a prospective observational study of children 3 to 18 years old with mild CSI evaluated at a level I pediatric trauma center from December 1, 2019, through July 31, 2021. Before emergency department discharge, patients received RCO use instructions and recommendation for follow-up with in-person neurosurgery clinic visit, neurosurgery telehealth visit, or in-person primary care provider visit. The family was responsible for arranging follow-up. Primary outcomes included compliance with follow-up and collar use. Results: Ninety-eight children (mean age, 11.3 ± 4.1 years) were included. Overall, follow-up contact was available for 51 patients (52%). At 1-week follow-up with 36 children, 64% were collar compliant, 13 had no pain (38% remained in RCO), 14 had mild pain without limitations, 8 had pain with some limitations, and 1 had significant pain. At 2-week follow-up with 31 children, 9 (29%) were collar compliant, 23 had no pain, 7 had mild pain without limitations, and 1 with significant persistent pain was found to have an odontoid fracture requiring C1–2 fusion. Patients/families often discontinued the use of the collar without follow-up (47%). Approximately half utilized a recommended clinical follow-up option for clearance, most often in neurosurgery clinic or using a neurosurgery telehealth visit. The mean time to follow-up was 11.34 ± 4.9 days (range, 3–25 days), and mean collar compliance lasted 9.8 ± 5.7 days (range, 1–25 days). No child experienced any short-term complications related to RCO use. Conclusions: In this pilot study, a substantial portion of children with mild CSIs discharged from the emergency department with an RCO did not adhere to compliance or follow-up recommendations. Persistent pain requires further evaluation.