Improved data on spinal motion restriction (SMR) use can improve pediatric prehospital guidelines and inform the appropriate use of this procedure. We sought to evaluate the prevalence and factors associated with SMR among injured children in the prehospital setting.

We performed a retrospective analysis using retrospective data using the 2022–2023 National Emergency Medical Services Information System datasets, including injured pediatric (<18 years) ground encounters at the scene transported to the hospital. We identified the percentage of encounters for which SMR was applied. We identified demographic and clinical associations with SMR application using a linear mixed effects model.

We identified 623,785 encounters for injured children (median age 13 years, IQR 6–15; 55.5 % for boys). Among these, 67,551 (10.8 %) had SMR applied in the prehospital setting. In multivariable analysis, SMR use was positively associated (odds ratio, 95 % confidence interval) with older age (1.05, 1.05–1.05), longer transport times (1.23, 1.20–1.25), altered consciousness (increasing odds ratios from 3.12 to 4.54 with worsening AVPU scores), high reported pain scores (1.24, 1.21–1.27 relative to low/medium pain), advanced life support transports (1.81, 1.74–1.88), tachycardia (1.11, 1.06–1.16), tachypnea (1.45, 1.37–1.52), bradypnea (1.15, 1.05–1.26). Hypotension was negatively associated with SMR (0.59, 0.54–0.65). Pedestrian and non-traffic MVCs were positively associated with SMR; mechanisms of falls, penetration with sharp objects, and environmental injuries were negatively associated with SMR.

We identified multiple factors associated with SMR use. These findings provide an opportunity to evaluate practices, track changes, and assess the impact of updated SMR guidelines in pediatric EMS.