• Brandi C Barnes, Pradip P Kamat, Courtney M McCracken, Matthew T Santore, Michael D Mallory, Harold K Simon, and Carmen Denease Sulton.
• Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
• J Emerg Med. 2019 Oct 1; 57 (4): 429-436.

BackgroundPediatric trauma patients with cervical spine (CS) immobilization using a cervical collar often require procedural sedation (PS) for radiologic imaging. The limited ability to perform airway maneuvers while CS immobilized with a cervical collar is a concern for emergency department (ED) staff providing PS.ObjectiveTo describe the use of PS and analgesia for radiologic imaging acquisition in pediatric trauma patients with CS immobilization.MethodsRetrospective medical record review of all trauma patients with CS immobilization at a high-volume pediatric trauma center was performed. Patient demographics, imaging modality, PS success, sedative and analgesia medications, and adverse events were analyzed. Patients intubated prior to arrival to the ED were excluded.ResultsA total of 1417 patients with 1898 imaging encounters met our inclusion criteria. A total of 398 patients required more than one radiographic imaging procedure. The median age was 8 years (range 3.8-12.75 years). Computed tomography of the head was used in 974 of the 1898 patients (51.3%). A total of 956 of the 1898 patients (50.4%) required sedatives or analgesics for their radiographic imaging, with 875 (91.5%) requiring a single sedative or analgesic agent, and 81 (8.5%) requiring more than one medication. Airway obstruction was the most common adverse event, occurring in 5 of 956 patients (0.3%). All imaging procedures were successfully completed.ConclusionOnly 50% of CS immobilized, nonintubated patients required a single sedative or analgesic medication for their radiologic imaging. Procedural success was high, with few adverse events.Copyright © 2019 Elsevier Inc. All rights reserved.

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