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Entwicklung eines neuen Protokolls zur präklinischen Immobilisation der Wirbelsäule bei Kindern und erste Anwendungsuntersuchung

Indikationsstellung anhand des E.M.S. IMMO Protocol Pediatric

Development and first application testing of a new protocol for preclinical spinal immobilization in children

Assessment of indications based on the E.M.S. IMMO Protocol Pediatric

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Zusammenfassung

Hintergrund

Um Sekundärschäden zu vermeiden, stellt die Immobilisation der potenziell verletzten Wirbelsäule eine Standardmaßnahme im präklinischen Traumamanagement dar. Immobilisationsprotokolle sollen dem notfallmedizinischen Fachpersonal helfen, richtige und schnelle Entscheidungen zu treffen. Die existierenden Protokolle für erwachsene Traumapatienten können nicht auf pädiatrische Patienten übertragen werden. Adäquate Protokolle für Kinder mit Wirbelsäulenverletzungen fehlen bisher.

Ziel der Arbeit

Ziele der Arbeit waren (i) die Entwicklung eines Protokolls zur Indikationsstellung der präklinischen Immobilisation der Wirbelsäule bei pädiatrischen Traumapatienten, welches auf der aktuellen wissenschaftlichen Literatur basiert, und (ii) die Analyse der Ergebnisqualität bei Anwendung des Protokolls durch notfallmedizinisches Fachpersonal.

Material und Methoden

Basierend auf einer strukturierten Literaturrecherche wurde eine neue Entscheidungshilfe zur präklinischen Immobilisation von pädiatrischen Traumapatienten entwickelt. Anschließend erfolgte anhand eines Fragebogens mit 4 Fallvignetten die Analyse der Ergebnisqualität bei der Anwendung des Protokolls. Hierzu musste für die 4 Fallvignetten die Indikation zur Immobilisation ohne und mit Verwendung des Protokolls gestellt werden.

Ergebnisse

Das E.M.S. IMMO Protocol Pediatric wurde auf Grundlage der bestehenden Literatur entwickelt. In der Untersuchung der Anwendbarkeit an 39 Studienteilnehmern (Notfallsanitäter, Notärzte etc.) zeigte sich, dass die Verwendung des E.M.S. IMMO Protocol Pediatric zu einer signifikant höheren Anzahl korrekter Indikationsstellungen führte. Insgesamt empfanden 38 Studienteilnehmer das Protokoll als hilfreich.

Diskussion

Auf der Grundlage der Literatur und unter Integration der gängigen Versorgungsstrategien von Traumapatienten wurde das E.M.S. IMMO Protocol Pediatric entwickelt. Die erste Anwendungsanalyse zeigt eine Verbesserung der Indikationsstellung.

Abstract

Background

To protect the spine from secondary damage, spinal immobilization is a standard procedure in prehospital trauma management. Immobilization protocols aim to support emergency medicine personnel in quick decision making but predominantly focus on the adult spine; however, trauma mechanisms and injury patterns in adults differ from those in children and applying adult prehospital immobilization protocols to pediatric patients may be insufficient. Adequate protocols for children with spinal injuries are currently unavailable.

Objective

The aim of this study was (i) to develop a protocol that supports decision making for prehospital spinal immobilization in pediatric trauma patients based on evidence from current scientific literature and (ii) to perform a first analysis of the quality of results if the protocol is used by emergency personnel.

Material and methods

Based on a structured literature search a new immobilization protocol was developed. Analysis of the quality of results was performed by a questionnaire containing four case scenarios in order to assess correct decision making. The decision about spinal immobilization was made without and with the utilization of the protocol.

Results

The E.M.S. IMMO Protocol Pediatric was developed based on the literature. The analysis of the quality of results was performed involving 39 emergency medicine providers. It could be shown that if the E.M.S. IMMO Protocol Pediatric was used, the correct type of immobilization was chosen more frequently. A total of 38 out of 39 participants evaluated the protocol as helpful.

Conclusion

The E.M.S. IMMO Protocol Pediatric provides decision-making support whether pediatric spine immobilization is indicated with respect to the cardiopulmonary status of the patient. In a first analysis, the E.M.S. IMMO Protocol Pediatric improves decision making by emergency medical care providers.

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Literatur

  1. Advanced Life Support Group (2017) Pre-hospital paediatric life support: a practical approach to emergencies. John Wiley and Sons Ltd., Hoboken

    Google Scholar 

  2. Akbarnia BA (1999) Pediatric spine fractures. Orthop. Clin. North Am. 30:521–536, x

  3. Anderson RCE, Scaife ER, Fenton SJ et al (2006) Cervical spine clearance after trauma in children. J Neurosurg 105:361–364

    Article  PubMed  Google Scholar 

  4. Apple JS, Kirks DR, Merten DF et al (1987) Cervical spine fractures and dislocations in children. Pediatr Radiol 17:45–49

    Article  CAS  PubMed  Google Scholar 

  5. Arbuthnot M, Mooney DP (2017) The sensitivity and negative predictive value of a pediatric cervical spine clearance algorithm that minimizes computerized tomography. J Pediatr Surg 52:130–135

    Article  PubMed  Google Scholar 

  6. Armstrong BP, Simpson HK, Crouch R et al (2007) Prehospital clearance of the cervical spine: does it need to be a pain in the neck? Emerg Med J 24:501–503

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Baerg J, Thirumoorthi A, Hazboun R et al (2017) Cervical spine injuries in young children: pattern and outcomes in accidental versus inflicted trauma. J Surg Res 219:366–373

    Article  PubMed  Google Scholar 

  8. Baker C, Kadish H, Schunk JE (1999) Evaluation of pediatric cervical spine injuries. Am J Emerg Med 17:230–234

    Article  CAS  PubMed  Google Scholar 

  9. Bandiera G, Stiell IG, Wells GA et al (2003) The Canadian C‑spine rule performs better than unstructured physician judgment. Ann Emerg Med 42:395–402

    Article  PubMed  Google Scholar 

  10. Benger J, Blackham J (2009) Why do we put cervical collars on conscious trauma patients? Scand J Trauma Resusc Emerg Med 17:44

    Article  PubMed  PubMed Central  Google Scholar 

  11. Boissy P, Shrier I, Briere S et al (2011) Effectiveness of cervical spine stabilization techniques. Clin J Sport Med 21:80–88

    Article  PubMed  Google Scholar 

  12. Brockmeyer DL, Ragel BT, Kestle JRW (2012) The pediatric cervical spine instability study. A pilot study assessing the prognostic value of four imaging modalities in clearing the cervical spine for children with severe traumatic injuries. Childs Nerv Syst 28:699–705

    Article  PubMed  Google Scholar 

  13. Brown RL, Brunn MA, Garcia VF (2001) Cervical spine injuries in children: a review of 103 patients treated consecutively at a level 1 pediatric trauma center. J Pediatr Surg 36:1107–1114

    Article  CAS  PubMed  Google Scholar 

  14. Browne GJ, Lam LT, Barker RA (2003) The usefulness of a modified adult protocol for the clearance of paediatric cervical spine injury in the emergency department. Emerg Med (fremantle) 15:133–142

    Article  Google Scholar 

  15. Burns EC, Yanchar NL (2011) Using cervical spine clearance guidelines in a pediatric population: a survey of physician practices and opinions. CJEM 13:1–6

    Article  PubMed  Google Scholar 

  16. Burton JH, Dunn MG, Harmon NR et al (2006) A statewide, prehospital emergency medical service selective patient spine immobilization protocol. J Trauma 61:161–167

    Article  PubMed  Google Scholar 

  17. Cordell WH, Hollingsworth JC, Olinger ML et al (1995) Pain and tissue-interface pressures during spine-board immobilization. Ann Emerg Med 26:31–36

    Article  CAS  PubMed  Google Scholar 

  18. Da Dalt L, Parri N, Amigoni A et al (2018) Italian guidelines on the assessment and management of pediatric head injury in the emergency department. Ital J Pediatr 44:7

    Article  PubMed  PubMed Central  Google Scholar 

  19. Davies G, Deakin C, Wilson A (1996) The effect of a rigid collar on intracranial pressure. Injury 27:647–649

    Article  CAS  PubMed  Google Scholar 

  20. Deutsche Gesellschaft Für Unfallchirurgie (2016) S3 – Leitlinie Polytrauma/Schwerverletzten-Behandlung AWMF-Register Nr. 012/019

  21. Dietrich AM, Ginn-Pease ME, Bartkowski HM et al (1991) Pediatric cervical spine fractures: predominantly subtle presentation. J Pediatr Surg 26:995–999 (discussion 999–1000)

    Article  CAS  PubMed  Google Scholar 

  22. Domeier RM, Frederiksen SM, Welch K (2005) Prospective performance assessment of an out-of-hospital protocol for selective spine immobilization using clinical spine clearance criteria. Ann Emerg Med 46:123–131

    Article  PubMed  Google Scholar 

  23. Dowd MD, Keenan HT, Bratton SL (2002) Epidemiology and prevention of childhood injuries. Crit Care Med 30:385–392

    Article  Google Scholar 

  24. Ehrlich PF, Wee C, Drongowski R et al (2009) Canadian C‑spine Rule and the National Emergency X‑Radiography Utilization Low-Risk Criteria for C‑spine radiography in young trauma patients. J Pediatr Surg 44:987–991

    Article  PubMed  Google Scholar 

  25. Eleraky MA, Theodore N, Adams M et al (2000) Pediatric cervical spine injuries: report of 102 cases and review of the literature. J Neurosurg 92:12–17

    CAS  PubMed  Google Scholar 

  26. European Resuscitation Council (2015) Paediatric advanced life support. Product reference: Poster_PAEDS_PALS_Algorithm_ENG_20150930. https://cprguidelines.eu/sites/573c777f5e61585a053d7ba5/content_entry573c77e35e61585a053d7bb2/573c784a5e61585a083d7bdb/files/Poster_PAEDS_PALS_Algorithm_ENG_V20151005_HRES.pdf

  27. Garton HJL, Hammer MR (2008) Detection of pediatric cervical spine injury. Neurosurgery 62:700–708

    Article  PubMed  Google Scholar 

  28. Givens TG, Polley KA, Smith GF et al (1996) Pediatric cervical spine injury: a three-year experience. J Trauma 41:310–314

    Article  CAS  PubMed  Google Scholar 

  29. Goutcher CM, Lochhead V (2005) Reduction in mouth opening with semi-rigid cervical collars. Br J Anaesth 95:344–348

    Article  CAS  PubMed  Google Scholar 

  30. Guilliams K, Wainwright MS (2016) Pathophysiology and Management of Moderate and Severe Traumatic Brain Injury in Children. J Child Neurol 31:35–45

    Article  PubMed  Google Scholar 

  31. Hadley MN, Zabramski JM, Browner CM et al (1988) Pediatric spinal trauma. Review of 122 cases of spinal cord and vertebral column injuries. J Neurosurg 68:18–24

    CAS  PubMed  Google Scholar 

  32. Hamilton MG, Myles ST (1992) Pediatric spinal injury: review of 174 hospital admissions. J Neurosurg 77:700–704

    Article  CAS  PubMed  Google Scholar 

  33. Hannon M, Mannix R, Dorney K et al (2015) Pediatric cervical spine injury evaluation after blunt trauma: a clinical decision analysis. Ann Emerg Med 65:239–247

    Article  PubMed  Google Scholar 

  34. Haut ER, Kalish BT, Efron DT et al (2010) Spine immobilization in penetrating trauma: more harm than good? J Trauma 68:115–120

    Article  PubMed  Google Scholar 

  35. Herman MJ, Brown KO, Sponseller PD et al. (2019) Pediatric Cervical Spine Clearance: A Consensus Statement and Algorithm from the Pediatric Cervical Spine Clearance Working Group. The Journal of Bone and Joint Surgery. American Volume 101:e1

  36. Hindman BJ, Santoni BG, Puttlitz CM et al (2014) Intubation biomechanics: laryngoscope force and cervical spine motion during intubation with Macintosh and Airtraq laryngoscopes. Anesthesiology 121:260–271

    Article  PubMed  Google Scholar 

  37. Hoffman JR, Mower WR, Wolfson AB et al (2000) Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X‑Radiography Utilization Study Group. N Engl J Med 343:94–99

    Article  CAS  PubMed  Google Scholar 

  38. Hoffman JR, Wolfson AB, Todd K et al (1998) Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X‑Radiography Utilization Study (NEXUS). Ann Emerg Med 32:461–469

    Article  CAS  PubMed  Google Scholar 

  39. Hood N, Considine J (2015) Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature. Australas Emerg Nurs J 18:118–137

    Article  PubMed  Google Scholar 

  40. Horodyski M, Dipaola CP, Conrad BP et al (2011) Cervical collars are insufficient for immobilizing an unstable cervical spine injury. J Emerg Med 41:513–519

    Article  PubMed  Google Scholar 

  41. Hunt K, Hallworth S, Smith M (2001) The effects of rigid collar placement on intracranial and cerebral perfusion pressures. Anaesthesia 56:511–513

    Article  CAS  PubMed  Google Scholar 

  42. Jaffe DM, Binns H, Radkowski MA et al (1987) Developing a clinical algorithm for early management of cervical spine injury in child trauma victims. Ann Emerg Med 16:270–276

    Article  CAS  PubMed  Google Scholar 

  43. Johnson DR, Hauswald M, Stockhoff C (1996) Comparison of a vacuum splint device to a rigid backboard for spinal immobilization. Am J Emerg Med 14:369–372

    Article  CAS  PubMed  Google Scholar 

  44. Kewalramani LS, Kraus JF, Sterling HM (1980) Acute spinal-cord lesions in a pediatric population: epidemiological and clinical features. Paraplegia 18:206–219

    CAS  PubMed  Google Scholar 

  45. Knox JB, Schneider JE, Cage JM et al (2014) Spine trauma in very young children: a retrospective study of 206 patients presenting to a level 1 pediatric trauma center. J Pediatr Orthop 34:698–702

    Article  PubMed  Google Scholar 

  46. Kokoska ER, Keller MS, Rallo MC et al (2001) Characteristics of pediatric cervical spine injuries. J Pediatr Surg 36:100–105

    Article  CAS  PubMed  Google Scholar 

  47. Kreinest M, Gliwitzky B, Grützner PA et al (2016) Untersuchung der Anwendbarkeit eines neuen Protokolls zur Immobilisation der Wirbelsäule. Notf Rettungsmed 19:473–482

    Article  Google Scholar 

  48. Kreinest M, Gliwitzky B, Schuler S et al (2016) Development of a new Emergency Medicine Spinal Immobilization Protocol for trauma patients and a test of applicability by German emergency care providers. Scand J Trauma Resusc Emerg Med 24:71

    Article  PubMed  PubMed Central  Google Scholar 

  49. Kreinest M, Goller S, Gliwitzky B et al (2017) Expertise of german paramedics concerning the prehospital treatment of patients with spinal trauma. Eur J Trauma Emerg Surg 43:371

    Article  CAS  PubMed  Google Scholar 

  50. Kreinest M, Goller S, Rauch G et al (2015) Application of Cervical Collars—An Analysis of Practical Skills of Professional Emergency Medical Care Providers. PLoS ONE 10:e143409

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Laham JL, Cotcamp DH, Gibbons PA et al (1994) Isolated head injuries versus multiple trauma in pediatric patients: do the same indications for cervical spine evaluation apply? Pediatr Neurosurg 21:221–226

    Article  CAS  PubMed  Google Scholar 

  52. Lee SL, Sena M, Greenholz SK et al (2003) A multidisciplinary approach to the development of a cervical spine clearance protocol: process, rationale, and initial results. J Pediatr Surg 38:358–362 (discussion 358–362)

    Article  PubMed  Google Scholar 

  53. Leonard JC (2013) Cervical spine injury. Pediatr Clin North Am 60:1123–1137

    Article  PubMed  Google Scholar 

  54. Leonard JC, Kuppermann N, Olsen C et al (2011) Factors associated with cervical spine injury in children after blunt trauma. Ann Emerg Med 58:145–155

    Article  PubMed  Google Scholar 

  55. Leonard JC, Mao J, Jaffe DM (2012) Potential adverse effects of spinal immobilization in children. Prehosp Emerg Care 16:513–518

    Article  PubMed  Google Scholar 

  56. Leonard JR, Jaffe DM, Kuppermann N et al (2014) Cervical spine injury patterns in children. Pediatr Electron Pages 133:e1179–1188

    Google Scholar 

  57. Liao S, Schneider NRE, Hüttlin P et al (2018) Motion and dural sac compression in the upper cervical spine during the application of a cervical collar in case of unstable craniocervical junction—A study in two new cadaveric trauma models. PLoS ONE 13:e195215

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Liao S, Schneider NRE, Weilbacher F et al (2018) Spinal movement and dural sac compression during airway management in a cadaveric model with atlanto-occipital instability. Eur Spine J 27:1295–1302

    Article  PubMed  Google Scholar 

  59. Luscombe MD, Williams JL (2003) Comparison of a long spinal board and vacuum mattress for spinal immobilisation. Emerg Med J 20:476–478

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Lykissas M, Gkiatas I, Spiliotis A et al (2019) Trends in pediatric cervical spine injuries in the United States in a 10-year period. J Orthop Surg 27:2309499019834734

    Article  Google Scholar 

  61. Maconochie IK, Bingham R, Eich C et al (2015) European Resuscitation Council Guidelines for Resuscitation 2015: Section 6. Paediatric life support. Resuscitation 95:223–248

    Article  PubMed  Google Scholar 

  62. Maxfield BA (2010) Sports-related injury of the pediatric spine. Radiol Clin North Am 48:1237–1248

    Article  PubMed  Google Scholar 

  63. Maynard FM, Bracken MB, Creasey G et al (1997) International Standards for Neurological and Functional Classification of Spinal Cord Injury. American Spinal Injury Association. Spinal Cord 35:266–274

    Article  PubMed  Google Scholar 

  64. Mccarthy C, Oakley E (2002) Management of suspected cervical spine injuries—the paediatric perspective. Accid Emerg Nurs 10:163–169

    Article  CAS  PubMed  Google Scholar 

  65. Mclaughlin C, Zagory JA, Fenlon M et al (2018) Timing of mortality in pediatric trauma patients: A National Trauma Data Bank analysis. J Pediatr Surg 53:344–351

    Article  PubMed  Google Scholar 

  66. Meldon SW, Brant TA, Cydulka RK et al (1998) Out-of-hospital cervical spine clearance: agreement between emergency medical technicians and emergency physicians. J Trauma 45:1058–1061

    Article  CAS  PubMed  Google Scholar 

  67. Münzberg M, Mahlke L, Bouillon B et al (2010) Six years of Advanced Trauma Life Support (ATLS) in Germany: the 100th provider course in Hamburg. Unfallchirurg 113:561–566

    Article  PubMed  Google Scholar 

  68. Nadarajah V, Jauregui JJ, Perfetti D et al (2018) What are the trends and demographics in sports-related pediatric spinal cord injuries? Phys Sportsmed 46:8–13

    Article  PubMed  Google Scholar 

  69. Nitecki S, Moir CR (1994) Predictive factors of the outcome of traumatic cervical spine fracture in children. J Pediatr Surg 29:1409–1411

    Article  CAS  PubMed  Google Scholar 

  70. Nolte PC, Uzun DD, Haske D et al (2019) Analysis of cervical spine immobilization during patient transport in emergency medical services. Eur J Trauma Emerg Surg. https://doi.org/10.1007/s00068-019-01143-z

    Article  PubMed  Google Scholar 

  71. Nypaver M, Treloar D (1994) Neutral cervical spine positioning in children. Ann Emerg Med 23:208–211

    Article  CAS  PubMed  Google Scholar 

  72. Oppenlander ME, Clark JC, Sonntag VKH et al (2014) Pediatric craniovertebral junction trauma. Adv Tech Stand Neurosurg 40:333–353

    Article  PubMed  Google Scholar 

  73. Orenstein JB, Klein BL, Gotschall CS et al (1994) Age and outcome in pediatric cervical spine injury: 11-year experience. Pediatr Emerg Care 10:132–137

    Article  CAS  PubMed  Google Scholar 

  74. Osenbach RK, Menezes AH (1992) Pediatric spinal cord and vertebral column injury. Neurosurgery 30:385–390

    Article  CAS  PubMed  Google Scholar 

  75. Parent S, Dimar J, Dekutoski M et al (2010) Unique features of pediatric spinal cord injury. Spine 35:S202–208

    Article  PubMed  Google Scholar 

  76. Partrick DA, Bensard DD, Moore EE et al (2000) Cervical spine trauma in the injured child: a tragic injury with potential for salvageable functional outcome. J Pediatr Surg 35:1571–1575

    Article  CAS  PubMed  Google Scholar 

  77. Patel JC, Tepas JJ, Mollitt DL et al (2001) Pediatric cervical spine injuries: defining the disease. J Pediatr Surg 36:373–376

    Article  CAS  PubMed  Google Scholar 

  78. Piatt J, Imperato N (2018) Epidemiology of spinal injury in childhood and adolescence in the United States: 1997–2012. J Neurosurg Pediatr 21:441–448

    Article  PubMed  Google Scholar 

  79. Pieretti-Vanmarcke R, Velmahos GC, Nance ML et al (2009) Clinical clearance of the cervical spine in blunt trauma patients younger than 3 years: a multi-center study of the american association for the surgery of trauma. J Trauma 67:543–549

    Article  PubMed  Google Scholar 

  80. Platzer P, Jaindl M, Thalhammer G et al (2007) Cervical spine injuries in pediatric patients. J Trauma 62:389–396

    Article  PubMed  Google Scholar 

  81. Purvis TE, De La Garza-Ramos R, Abu-Bonsrah N et al (2018) External fixation and surgical fusion for pediatric cervical spine injuries: Short-term outcomes. Clin Neurol Neurosurg 168:18–23

    Google Scholar 

  82. Rachesky I, Boyce WT, Duncan B et al (1987) Clinical prediction of cervical spine injuries in children. Radiogr Abnorm Am J Dis Child 141:199–201

    Article  CAS  Google Scholar 

  83. Regensburger AP, Konrad V, Trollmann R et al (2019) Treatment of severe traumatic brain injury in German pediatric intensive care units—a survey of current practice. Childs Nerv Syst 35:815–822

    Article  CAS  PubMed  Google Scholar 

  84. Ribeiro Da Silva M, Linhares D, Cacho Rodrigues P et al (2016) Paediatric cervical spine injures. Nineteen years experience of a single centre. International Orthopaedics (SICOT) 40:1111–1116

    Article  Google Scholar 

  85. Rozzelle CJ, Aarabi B, Dhall SS et al (2013) Management of pediatric cervical spine and spinal cord injuries. Neurosurgery 72(Suppl 2):205–226

    Article  PubMed  Google Scholar 

  86. Schafermeyer RW, Ribbeck BM, Gaskins J et al (1991) Respiratory effects of spinal immobilization in children. Ann Emerg Med 20:1017–1019

    Article  CAS  PubMed  Google Scholar 

  87. Shin JI, Lee NJ, Cho SK (2016) Pediatric Cervical Spine and Spinal Cord Injury: A National Database Study. Spine 41:283–292

    Article  PubMed  Google Scholar 

  88. Shrier I, Boissy P, Lebel K et al (2015) Cervical Spine Motion during Transfer and Stabilization Techniques. Prehosp Emerg Care 19:116–125

    Article  PubMed  Google Scholar 

  89. Stiell IG, Clement CM, Mcknight RD et al (2003) The Canadian C‑spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med 349:2510–2518

    Article  CAS  PubMed  Google Scholar 

  90. Stiell IG, Wells GA, Vandemheen KL et al (2001) The Canadian C‑spine rule for radiography in alert and stable trauma patients. JAMA 286:1841–1848

    Article  CAS  PubMed  Google Scholar 

  91. Totten VY, Sugarman DB (1999) Respiratory effects of spinal immobilization. Prehosp Emerg Care 3:347–352

    Article  CAS  PubMed  Google Scholar 

  92. Vaillancourt C, Stiell IG, Beaudoin T et al (2009) The out-of-hospital validation of the Canadian C‑Spine Rule by paramedics. Ann Emerg Med 54(61):663–671.e6

    Article  PubMed  Google Scholar 

  93. Velopulos CG, Shihab HM, Lottenberg L et al (2018) Prehospital spine immobilization/spinal motion restriction in penetrating trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma (EAST). J Trauma Acute Care Surg 84:736–744

    Article  PubMed  Google Scholar 

  94. Vitale MG, Goss JM, Matsumoto H et al (2006) Epidemiology of pediatric spinal cord injury in the United States: years 1997 and 2000. J Pediatr Orthop 26:745–749

    Article  PubMed  Google Scholar 

  95. Walters BC, Hadley MN, Hurlbert RJ et al (2013) Guidelines for the management of acute cervical spine and spinal cord injuries: 2013 update. Neurosurgery 60(Suppl 1):82–91

    Article  PubMed  Google Scholar 

  96. Wang MY, Kim KA, Griffith PM et al (2001) Injuries from falls in the pediatric population: an analysis of 729 cases. J Pediatr Surg 36:1528–1534

    Article  CAS  PubMed  Google Scholar 

  97. Wölfl CG, Bouillon B, Lackner CK et al (2008) Prehospital Trauma Life Support® (PHTLS®). Unfallchirurg 111:688–694

    Article  PubMed  Google Scholar 

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Danksagung

Wir bedanken uns bei Dr. Eva-Kristin Renker (EKR) und Prof. Dr. Dr. Peter Schmittenbecher (PS) für die eingebrachte Expertise und kritische Durchsicht des Protokolls.

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  1. Klinik für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, 67071, Ludwigshafen, Deutschland

    Philip C. Nolte, Davut D. Uzun, Shiyao Liao, Paul A. Grützner, Matthias Münzberg &  Michael Kreinest

  2. Klinik für Orthopädie, Zhejiang Provincial People’s Hospital and People’s Hospital of Hangzhou Medical College, Hangzhou, Volksrepublik China

    Shiyao Liao

  3. Kindernotaufnahme, Städtisches Klinikum Karlsruhe, 76133, Karlsruhe, Deutschland

    Matthias Kuch

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P.C. Nolte, D.D. Uzun, S. Liao, M. Kuch, P.A. Grützner, M. Münzberg und M. Kreinest geben an, dass kein Interessenkonflikt besteht.

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Nolte, P.C., Uzun, D.D., Liao, S. et al. Entwicklung eines neuen Protokolls zur präklinischen Immobilisation der Wirbelsäule bei Kindern und erste Anwendungsuntersuchung. Unfallchirurg 123, 289–301 (2020). https://doi.org/10.1007/s00113-019-00744-y

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  • DOI: https://doi.org/10.1007/s00113-019-00744-y

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