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The article by Martin and colleagues1 reviewing patterns and risks in spinal trauma highlights the increased incidence of spinal cord injury (SCI) and spinal cord injury without radiological abnormality (SCIWORA) in young children. They suggest that without clinical suspicion proper evaluation of the child’s spine may not occur, and refer to an audit by Skellet and colleagues2 that shows inadequate spinal immobilisation of paediatric trauma patients on arrival of the paediatric retrieval team.
Preventing secondary injury during transfer (movement of patients between hard surfaces in close proximity) and transport (patient movement between facilities) is particularly important.
There are a number of devices available to facilitate spinal immobilisation during transfer and transport. These include spinal board (SB), vacuum mattress (VM), patslide, and scoop device in combination with traditional hard collar, blocks, and tapes to provide cervical spine immobilisation
We carried out a survey to identify the current practices in immobilisation, transfer, and transport of the paediatric trauma patient with actual or potential SCI. Postal questionnaires were sent to the retrieval coordinators in 18 UK paediatric ICUs asking about methods of spinal immobilisation during transfer and transport of paediatric trauma patients and existence of guidelines for management of that population.
There was a 100% response rate (postal plus follow up phone calls to two centres). Only 27% (5/18) of retrieval services employed practice guidelines. For patient transfer, 27% (5/18) of retrieval services utilised a patslide device alone and 50% (9/18) utilised a patslide in combination with a vacuum mattress and/or spinal board (table 1). For patient transport, 67% (12/18) of services had a consistent approach (table 2). A spinal board, either alone or with padding, was used by 72% (13/18) of services for at least some of their patient transports.
One hundred per cent of services used the traditional triad of hard collar, sandbags/blocks, and tape/straps for maintaining cervical spine immobilisation.
As Martin et al have described, SCI and SCIWORA occur more frequently in younger children. Without an obvious radiological abnormality, these injuries may potentially be overlooked. Prevention of Secondary injury is thus important during transport of at risk patients. Our survey illustrates that there is a lack of a consistent approach to spinal immobilisation during transfer and transport of paediatric trauma patients. There is also continuing use of spinal boards despite evidence that they should only play a role during extrication of patients in the pre-hospital setting3 and that vacuum mattresses may confer benefits in terms of patient safety and comfort.4
The development of best practice guidelines may lead to a more consistent approach.
Competing interests: none declared