New guidelines for on-field treatment and emergency transport of young athletes with suspected neck injuries should recommend keeping both helmet and shoulder pads on for initial stabilization and transport, followed by removal of both, once the patient is in a controlled setting, according to new research released March 8 at the 2008 American Orthopaedic Society for Sports Medicine Specialty Day at The Moscone Center.
"There was a clear hole in on-the-field guidelines in the treatment of young (8-14 year olds) contact and collision sports athletes with possible neck injuries," says first author and study presenter Gehron Treme, MD, former sports medicine fellow at the University of Virginia, now with the Center for Orthopaedics in Lake Charles, LA. "Skeletal proportions are different in children than adults. Kids have larger heads than torsos. With this study, we looked to see if this disproportion would result in a different recommendation, such as removing the helmet only. Our study found, however, just as is the case with adults, that both the helmet and shoulder pads should be left on for initial treatment and removed as a unit once the patient is stabilized."
Only car accidents and falls had a higher frequency of neck injuries in kids than sports participation. Neck injuries in football, ice hockey and lacrosse are rare, but can be catastrophic, according to Treme. Football players represented 29 percent of the cases of children with neck injuries from sports participation. In particular, the number of 7 -- 17-year-olds playing tackle football increased by nearly 45 percent between 1997 and 2006, according to the National Sporting Goods Association.
"Although these events are uncommon, they can be tragic," says Treme. "The initial treatment, usually within the first 10 minutes, is critical to how the patient will do long term. The goal, of course, is to avoid paralysis or neurological damage."
Treme and David Diduch, MD, principle investigator, professor, and team physician at University of Virginia studied 31 boys from a local youth football league between the ages of 8 and 14. X-rays were taken of each child lying down wearing shoulder pads only, wearing helmet and shoulder pads and wearing no equipment. Next, they measured the alignment of the head, neck and spine to determine if the head tipped back, risking further damage. After examining the X-rays, the study investigators determined that there was no statistically significant difference in alignment when the children wore no equipment compared to wearing both helmet and shoulder pads. However, alignment changes seen with shoulder pads only were considered unacceptable and could place the athlete at risk if the helmet alone was removed.
"With this study, there is at least some information we can use for the 8 -14 year old age range, in the unfortunate event of suspected neck injuries on the field," said Treme. "The 'all or nothing' policy for adult emergency on-field treatment is also appropriate for kids between 8 and 14."
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