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.

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).

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.

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.

儿科患者的颈椎牵引是治疗颈椎创伤和畸形的一种不常见但非常宝贵的技术。尽管它有用，但几乎没有经验证据来指导其实施，大多数从业者采用定制或修改的成人协议。基于专家的最佳实践可能会改善接受颈椎牵引的儿童的护理。在这项研究中，作者旨在就儿科颈椎牵引的使用达成共识并建立最佳实践，以提高其利用率、安全性和有效性。

一种改良的德尔菲法被用来试图确定关于小儿颈椎牵引的使用和实施的共识领域。一份关于小儿颈椎牵引的文献综述以及对当前实践的调查以电子方式分发给一组 20 名具有小儿颈椎专业知识的委员会认证的小儿神经外科医生和整形外科医生。然后制定了 60 份声明并分发给该小组。在面对面的会议上讨论了第二次调查的结果，从而达成了进一步的共识。共识被定义为在 4 点李克特量表（非常同意、同意、不同意、非常不同意）上 ≥ 80% 的同意。

在第一轮之后，就以下主题达成了 40 项共识：牵引的目标、适应症和禁忌症 (12)、牵引前成像 (6)、各种牵引技术的实际应用和启动 (8)、创伤和畸形患者 (8) 和牵引相关并发症的管理 (6)。在第二轮之后，另外 9 项声明达成了与牵引的目标/适应症/禁忌症 (4)、牵引的启动 (4) 和并发症管理 (1) 相关的共识。所有参与者都愿意将共识声明纳入他们的实践中。

为了改进和标准化儿科患者颈椎牵引的使用，作者确定了 49 条最佳实践建议，这些建议是通过使用改良的德尔菲技术的儿科脊柱专家多学科小组达成共识而产生的。需要进一步研究以确定实施这些做法是否可以减少并发症并改善儿童的预后。