U of U School of Medicine and Primary Children's Hospital Lead Pediatric Cervical Collar Study
The University of Utah’s Spencer Fox Eccles School of Medicine and Primary Children’s Hospital are launching an innovative multi-center study, under the leadership of Katie Russell, MD, to build a better understanding of best practices for cervical collar removal in pediatric trauma patients.
Russell is the trauma medical director for Primary Children’s Hospital, and an associate professor in the School of Medicine, giving her extensive experience in pediatric trauma. Previous observations and research led Russell to studying cervical collar removal to find a way to lessen the time patients spend in the collars.
“The exact procedures you should follow to clear the cervical spine for children is not clear,” Russell said. “Every time somebody has trauma, you have to worry about the possibility of a cervical spine injury, but if they don't have a spine injury then we need to be able to take the cervical collars off in a timely manner.”
Existing Challenges
Cervical collars are used to prevent secondary spinal cord damage after an initial trauma occurs. While only about 1% of pediatric trauma patients experience significant spinal injuries and 10% minor injuries, current guidelines require caregivers keep the collar in place until they have a normal clinical examination, or an MRI is performed to ensure no spinal damage is present.
In adults, the cervical collars can be removed after a normal CT scan, but prevailing thought regarding the differing needs for children has kept those same guidelines from being used in pediatric treatment.
“Kids are different, they’re still growing and have ligamentous laxity and incomplete boney ossification, so it’s important to make sure we don’t miss anything,” Russell said. “But my hypothesis is that CT scans are highly sensitive in pediatric cases and can successfully identify clinically significant cervical spine injuries, at least in adolescent patients if not in all children.”
The early removal of cervical collars would prevent difficulties that often occur from delayed MRIs. Many pediatric patients are unable to have an MRI immediately after being admitted to the hospital, often because of head injuries. The delay can lead to pressure sores and make overall treatment more difficult due to the cumbersome nature of the collars.
Meeting the Need
While extensive research exists regarding adult cervical collar removal, few studies exist for pediatric best practices, and even fewer are prospective projects. Through her previous research, Russell identified a gap in understanding regarding cervical collar guidelines in pediatric trauma.
“This all started when I came to Primary Children’s and we had a few ICU patients who weren’t able to have an MRI, and one developed a pressure sore,” Russell said. “I thought to myself, there’s got to be a way to clear these collars sooner. My mentor Dr. Brockmeyer encouraged me to study it.”
Russell’s insight led her to undertake an extended retrospective study examining patient data related to removal of cervical collars. The results of that research indicated that Russell might be correct – the cervical collars can likely be removed sooner.
This new study is prospective, building on Russell’s previous work, allowing researchers to collect rich data and directly observe pediatric trauma patients. The team of medical providers involved will examine whether a CT scan for critically injured patients and XRAYS for less severe cases are sensitive enough to determine if spinal injuries have been sustained.
The results of the study will be used to build a foundation for updated guidelines, which Russell hopes can be shared with the wider pediatric medical community.
Nationwide Collaboration
To complete the study, Russell’s team in Utah will work with more than 60 medical teams across the country to collect data. The goal is to enroll 22,000 children in the study who are admitted to trauma centers with cervical spine imaging after trauma.
While Russell is leading the research, she understands that working with other centers will be vital in collecting enough data. She began recruiting other trauma teams in 2021, collaborating with both pediatric and adult trauma centers to account for areas where pediatric patients only have access to adult trauma centers.
“We really want this study to bridge the gap between pediatric centers and adult centers because our adult colleagues are seeing almost 80% of pediatric trauma patients in a lot of areas,” Russell explained. “A lot of patients don’t have access to a pediatric trauma center, so it is important for us to collaborate with a broad group of centers.”
The School of Medicine’s Department of Surgery and Primary Children’s Hospital will lead the charge, but the group of centers involved will work together to collect data from trauma centers across the country, including the University of Southern California, Phoenix Children’s Hospital, the University of Colorado and Colorado Children’s Hospital, Cincinnati Children’s Hospital, the Children’s Hospital of Philadelphia, Shock Trauma, and John’s Hopkin’s, to name a few.
While the full group of trauma centers won’t be completely online until June 2024, data collection has already begun, with 3,000 pediatric patients currently enrolled. The study is expected to take approximately two and a half years to complete.
Future Impacts
The final research article, which will have nearly 150 co-authors, will provide a comprehensive look at data from every corner of the country.
As the study officially launches, the implications for the future are promising. While Russell’s hypothesis might not be proven to be correct, she noted that the results are only one aspect of the importance of the study.
The data collected, regardless of outcome, will provide the foundation for improved guidelines for cervical collar removal in pediatric trauma, allowing for increased quality in patient care. Additionally, the research will likely lead to further studies on the topic, paving the way for further advances in pediatric trauma care.
Russell noted, “This is a small step, but clearing the cervical spine is one of the most important things we can do as trauma surgeons, so I hope this study helps our ability to do that.”