Cervical Collar-Associated Pressure Injury in Pediatric Trauma Patients: A Western Pediatric Surgery Research Consortium Study

Caroline Melhado; Katie W Russell; Shannon N Acker; Benjamin E Padilla; Katrine Lofberg; Ryan G Spurrier; Bryce Robinson; Stephanie Chao; Romeo C Ignacio; Mark Ryan; Aaron R Jensen; Western Pediatric Surgery Research Consortium Cervical Spine Injury Study Group

doi:10.1016/j.jpedsurg.2023.10.021

Cervical Collar-Associated Pressure Injury in Pediatric Trauma Patients: A Western Pediatric Surgery Research Consortium Study

J Pediatr Surg. 2024 Feb;59(2):326-330. doi: 10.1016/j.jpedsurg.2023.10.021. Epub 2023 Oct 29.

Collaborators

Western Pediatric Surgery Research Consortium Cervical Spine Injury Study Group:
Kurtis Auguste¹², Catherine Beni¹³, Bruno P Braga¹⁴, Robert T Buckley¹⁵, Jason Chu¹⁶, Rachelle Durand¹⁷, Gretchen M Floan¹⁸, David D Gonda¹⁹, Rajiv R Iyer²⁰, Ramin Jamshidi²¹, Korgun Koral²², Peter G Kruk²³, Ken Linnau²⁴, Chia-Shang Jason Liu²⁵, Kathryn McNevin²⁶, Brent O'Neill²⁷, Samir Pandya²⁸, Natalya E Polukoff²⁹, Connor Prendergast³⁰, Laura M Prolo³¹, John Rampton³², Michael Regner³³, Jennifer Ronecker³⁴, Akanksha Sabapaty³⁵, Christine Sayama³⁶, Leigh Selesner³⁷, Karch M Smith³⁸, Nick Stence³⁹, Jaclyn Thiessen⁴⁰, Elizabeth Tong⁴¹, Jennifer A Vaughn⁴²

Affiliations

¹ University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA. Electronic address: caroline.melhado@ucsf.edu.
² University of Utah Health, Salt Lake City, UT, USA. Electronic address: katie.russell@hsc.utah.edu.
³ Children's Hospital Colorado, Aurora, CO, USA. Electronic address: shannon.acker@childrenscolorado.org.
⁴ Phoenix Children's Hospital, Phoenix, AZ, USA. Electronic address: bpadilla@phoenixchildrens.com.
⁵ Oregon Health & Sciences University, Portland, OR, USA. Electronic address: Katrine.lofberg@gmail.com.
⁶ Children's Hospital Los Angeles, Los Angeles, CA, USA. Electronic address: rspurrier@chla.usc.edu.
⁷ University of Washington School of Medicine, Seattle, WA, USA. Electronic address: brobinso@uw.edu.
⁸ Stanford University, Palo Alto, CA, USA. Electronic address: sdchao1@stanford.edu.
⁹ University of California San Diego, San Diego, CA, USA. Electronic address: r1ignacio@health.ucsd.edu.
¹⁰ University of Texas Southwestern, Dallas, TX, USA. Electronic address: mark.ryan@utsouthwestern.edu.
¹¹ University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA. Electronic address: Aaron.Jensen@UCSF.edu.
¹² University of California San Francisco and UCSF Benioff Children's Hospitals, San Francisco, CA, USA. Electronic address: Kurtis.Auguste@ucsf.edu.
¹³ University of Washington School of Medicine, Seattle, WA, USA. Electronic address: cathbeni@uw.edu.
¹⁴ University of Texas Southwestern, Dallas, TX, USA. Electronic address: Bruno.Braga@UTSouthwestern.edu.
¹⁵ University of Washington School of Medicine, Seattle, WA, USA. Electronic address: robuck@uw.edu.
¹⁶ Children's Hospital Los Angeles, Los Angeles, CA, USA. Electronic address: jachu@chla.usc.edu.
¹⁷ University of California San Francisco and UCSF Benioff Children's Hospitals, San Francisco, CA, USA. Electronic address: Rachelle.Durand@ucsf.edu.
¹⁸ University of California San Diego, San Diego, CA, USA. Electronic address: gfloan702@gmail.com.
¹⁹ University of California San Diego, San Diego, CA, USA. Electronic address: dgonda@rchsd.org.
²⁰ University of Utah, Salt Lake City, UT, USA. Electronic address: rajiv.iyer@hsc.utah.edu.
²¹ Phoenix Children's Hospital, Phoenix, AZ, USA. Electronic address: rjamshidi@phoenixchildrens.com.
²² University of Texas Southwestern, Dallas, TX, USA. Electronic address: Korgun.Koral@utsouthwestern.edu.
²³ University of California San Diego, San Diego, CA, USA. Electronic address: pkruk@rchsd.org.
²⁴ University of Washington School of Medicine, Seattle, WA, USA. Electronic address: klinnau@uw.edu.
²⁵ Children's Hospital Los Angeles, Los Angeles, CA, USA. Electronic address: cjliu@chla.usc.edu.
²⁶ University of Washington School of Medicine, Seattle, WA, USA. Electronic address: katemc27@uw.edu.
²⁷ Children's Hospital Colorado, Aurora, CO, USA. Electronic address: boneill1@pennstatehealth.psu.edu.
²⁸ University of Texas Southwestern, Dallas, TX, USA. Electronic address: samir.pandya@utsouthwestern.edu.
²⁹ University of Utah, Salt Lake City, UT, USA. Electronic address: u0770115@utah.edu.
³⁰ Children's Hospital Colorado, Aurora, CO, USA. Electronic address: connor.dewey@gmail.com.
³¹ Stanford University, Palo Alto, CA, USA. Electronic address: lmprolo@stanford.edu.
³² University of Utah, Salt Lake City, UT, USA. Electronic address: john.rampton@imail.org.
³³ Oregon Health & Sciences University, Portland, OR, USA. Electronic address: regnerm@ohsu.edu.
³⁴ Phoenix Children's Hospital, Phoenix, AZ, USA. Electronic address: jronecker@phoenixchildrens.com.
³⁵ Stanford University, Palo Alto, CA, USA. Electronic address: akankss@stanford.edu.
³⁶ Oregon Health & Sciences University, Portland, OR, USA. Electronic address: sayama@ohsu.edu.
³⁷ Oregon Health & Sciences University, Portland, OR, USA. Electronic address: selesner@ohsu.edu.
³⁸ University of Utah, Salt Lake City, UT, USA. Electronic address: karch.smith@hsc.utah.edu.
³⁹ Children's Hospital Colorado, Aurora, CO, USA. Electronic address: Nicholas.Stence@ucdenver.edu.
⁴⁰ Oregon Health & Sciences University, Portland, OR, USA. Electronic address: thiessen@ohsu.edu.
⁴¹ Stanford University, Palo Alto, CA, USA. Electronic address: etong@stanford.edu.
⁴² Phoenix Children's Hospital, Phoenix, AZ, USA. Electronic address: jvaughn2@phoenixchildrens.com.

PMID: 38030530
DOI: 10.1016/j.jpedsurg.2023.10.021

Abstract

Background: Healthcare-associated pressure injuries (HAPI) are known to be associated with medical devices and are preventable. Cervical spine immobilization is commonly utilized in injured children prior to clinical clearance or for treatment of an unstable cervical spinal injury. The frequency of HAPI has been quantified in adults with cervical spine immobilization but has not been well-described in children. The aim of this study was to describe characteristics of children who developed HAPI associated with cervical immobilization.

Methods: We analyzed a retrospective cohort of children (0-18 years) who developed a stage two or greater cervical HAPI. This cohort was drawn from an overall sample of 49,218 registry patients treated over a five-year period (2017-2021) at ten pediatric trauma centers. Patient demographics, injury characteristics, and cervical immobilization were tabulated to describe the population.

Results: The cohort included 32 children with stage two or greater cervical HAPI. The median age was 5 years (IQR 2-13) and 78% (n = 25) were admitted to the intensive care unit. The median (IQR) time to diagnosis of HAPI was 11 (7-21) days post-injury. The majority of cervical HAPI (78%, 25/32) occurred in children requiring immobilization for cervical injuries, with only four children developing HAPI after wearing a prophylactic cervical collar in the absence of a cervical spine injury.

Conclusion: Advanced-stage HAPI associated with cervical collar use in pediatric trauma patients is rare and usually occurs in patients with cervical spine injuries requiring immobilization for treatment. More expedient cervical spine clearance with MRI is unlikely to substantially reduce cervical HAPI in injured children.

Level of evidence: Level III (Epidemiologic and Prognostic).

Keywords: Cervical vertebrae; Child; Immobilization; Pressure ulcer; Spinal injuries; Trauma centers.

MeSH terms

Adolescent
Cervical Vertebrae / injuries
Child
Child, Preschool
Humans
Neck
Pressure Ulcer*
Retrospective Studies
Spinal Injuries* / epidemiology
Spinal Injuries* / etiology
Spinal Injuries* / therapy
Trauma Centers