Abstract
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.
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.
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.
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 III (Epidemiologic and Prognostic).
What is currently known about this topic?
•Healthcare-associated pressure injury is known to occur in children with medical devices, but the true incidence associated with cervical collars in pediatric trauma patients is not known.
What new information is contained in this article?
•Advanced stage pressure injuries associated with cervical collars are rare, and most commonly occur in patients with injuries that require immobilization and not with short-term use of prophylactic cervical immobilization while injuries are defined.