TY - JOUR
T1 - Development of best practices in the utilization and implementation of pediatric cervical spine traction
T2 - A modified Delphi study
AU - Alexiades, Nikita G.
AU - Shao, Belinda
AU - Braga, Bruno P.
AU - Bonfield, Christopher M.
AU - Brockmeyer, Douglas L.
AU - Browd, Samuel R.
AU - DiLuna, Michael
AU - Groves, Mari L.
AU - Hankinson, Todd C.
AU - Jea, Andrew
AU - Leonard, Jeffrey R.
AU - Lew, Sean M.
AU - Limbrick, David D.
AU - Mangano, Francesco T.
AU - Martin, Jonathan
AU - Pahys, Joshua
AU - Powers, Alexander
AU - Proctor, Mark R.
AU - Rodriguez, Luis
AU - Rozzelle, Curtis
AU - Storm, Phillip B.
AU - Anderson, Richard C.E.
N1 - Publisher Copyright:
© 2021 American Association of Neurological Surgeons. All rights reserved.
PY - 2021/6
Y1 - 2021/6
N2 - OBJECTIVE Cervical traction in pediatric patients is an uncommon but invaluable technique in the management of cervical trauma and deformity. Despite its utility, little empirical evidence exists to guide its implementation, with most practitioners employing custom or modified adult protocols. Expert-based best practices may improve the care of children undergoing cervical traction. In this study, the authors aimed to build consensus and establish best practices for the use of pediatric cervical traction in order to enhance its utilization, safety, and efficacy. METHODS A modified Delphi method was employed to try to identify areas of consensus regarding the utilization and implementation of pediatric cervical spine traction. A literature review of pediatric cervical traction was distributed electronically along with a survey of current practices to a group of 20 board-certified pediatric neurosurgeons and orthopedic surgeons with expertise in the pediatric cervical spine. Sixty statements were then formulated and distributed to the group. The results of the second survey were discussed during an in-person meeting leading to further consensus. Consensus was defined as ≥ 80% agreement on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree). RESULTS After the initial round, consensus was achieved with 40 statements regarding the following topics: Goals, indications, and contraindications of traction (12), pretraction imaging (6), practical application and initiation of various traction techniques (8), protocols in trauma and deformity patients (8), and management of traction-related complications (6). Following the second round, an additional 9 statements reached consensus related to goals/indications/contraindications of traction (4), related to initiation of traction (4), and related to complication management (1). All participants were willing to incorporate the consensus statements into their practice. CONCLUSIONS In an attempt to improve and standardize the use of cervical traction in pediatric patients, the authors have identified 49 best-practice recommendations, which were generated by reaching consensus among a multidisciplinary group of pediatric spine experts using a modified Delphi technique. Further study is required to determine if implementation of these practices can lead to reduced complications and improved outcomes for children.
AB - OBJECTIVE Cervical traction in pediatric patients is an uncommon but invaluable technique in the management of cervical trauma and deformity. Despite its utility, little empirical evidence exists to guide its implementation, with most practitioners employing custom or modified adult protocols. Expert-based best practices may improve the care of children undergoing cervical traction. In this study, the authors aimed to build consensus and establish best practices for the use of pediatric cervical traction in order to enhance its utilization, safety, and efficacy. METHODS A modified Delphi method was employed to try to identify areas of consensus regarding the utilization and implementation of pediatric cervical spine traction. A literature review of pediatric cervical traction was distributed electronically along with a survey of current practices to a group of 20 board-certified pediatric neurosurgeons and orthopedic surgeons with expertise in the pediatric cervical spine. Sixty statements were then formulated and distributed to the group. The results of the second survey were discussed during an in-person meeting leading to further consensus. Consensus was defined as ≥ 80% agreement on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree). RESULTS After the initial round, consensus was achieved with 40 statements regarding the following topics: Goals, indications, and contraindications of traction (12), pretraction imaging (6), practical application and initiation of various traction techniques (8), protocols in trauma and deformity patients (8), and management of traction-related complications (6). Following the second round, an additional 9 statements reached consensus related to goals/indications/contraindications of traction (4), related to initiation of traction (4), and related to complication management (1). All participants were willing to incorporate the consensus statements into their practice. CONCLUSIONS In an attempt to improve and standardize the use of cervical traction in pediatric patients, the authors have identified 49 best-practice recommendations, which were generated by reaching consensus among a multidisciplinary group of pediatric spine experts using a modified Delphi technique. Further study is required to determine if implementation of these practices can lead to reduced complications and improved outcomes for children.
KW - Cervical spine deformity
KW - Cervical spine traction
KW - Cervical spine trauma
KW - Modified Delphi method
UR - http://www.scopus.com/inward/record.url?scp=85107269535&partnerID=8YFLogxK
U2 - 10.3171/2020.10.PEDS20778
DO - 10.3171/2020.10.PEDS20778
M3 - Article
C2 - 33799292
AN - SCOPUS:85107269535
SN - 1933-0707
VL - 27
SP - 649
EP - 660
JO - Journal of Neurosurgery: Pediatrics
JF - Journal of Neurosurgery: Pediatrics
IS - 6
ER -