Factors which affect the application and implementation of a spinal motion restriction protocol by prehospital providers in a low resource setting: A scoping review

Geduld, Charlene; Müller, H; Saunders, Colleen

doi:10.1016/j.afjem.2022.08.005

Cited by 7 publications

(10 citation statements)

References 73 publications

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“…Growing literature arguing against routine c‐collar application has prompted renewed attention to decreasing the overuse of c‐collars 3,4,6 . Guidelines for the prehospital use of C‐spine clearance and SMR typically model the National Emergency X‐Radiography Utilization Study (NEXUS) and the Canadian C‐spine Rule (CCR) criteria, designed to rule out clinically insignificant cervical spinal injuries in blunt force trauma 11,12 . The NEXUS decision‐making tool's five criteria— lack of midline tenderness, no focal neurologic deficit, adequate alertness, no intoxication, and no distracting injury—demonstrate a high negative predictive value in practice 12 .…”

Section: Discussionmentioning

confidence: 99%

“…Literature suggests that age may be an appropriate consideration in the application of different EMS protocols. Generally, CCR‐based guidelines are thought to be more effective than NEXUS in the context of patients over 65 11,13 . Future investigations are necessary to investigate the use of different protocols in older adults to provide evidence‐based recommendations for an age‐based practice 15…”

Section: Discussionmentioning

confidence: 99%

“…3,4,6 Guidelines for the prehospital use of C-spine clearance and SMR typically model the National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian C-spine Rule (CCR) criteria, designed to rule out clinically insignificant cervical spinal injuries in blunt force trauma. 11,12 The NEXUS decision-making tool's five criteria-lack of midline tenderness, no focal neurologic deficit, adequate alertness, no intoxication, and no distracting injury-demonstrate a high negative predictive value in practice. 12 Nonetheless, this tool has shown to be highly subjective and has questionable reliability in populations over the age of 65.…”

Section: Discussionmentioning

confidence: 99%

“…Generally, CCRbased guidelines are thought to be more effective than NEXUS in the context of patients over 65. 11,13 Future investigations are necessary to investigate the use of different protocols in older adults to provide evidence-based recommendations for an age-based practice. 15 In the context of penetrating trauma, C-spine stabilization has been deemed a harmful practice in recent literature.…”

Section: Discussionmentioning

confidence: 99%

“…Despite a growing consensus on evidence-based recommendations for prehospital spine stabilization, the process of standardizing EMS protocols has been shown to have barriers, including nonstandardized terminology used in guidelines, problems enforcing compliance to guidelines, and the variability in qualification and skills in EMS providers. 11 Studies have also shown that EMS providers tend to be more conservative in the prehospital trauma setting than emergency physicians, which contributes to the overuse of immobilization. 17,18 To date, the literature has provided limited discourse on the evolving trends in spine immobilization practices.…”

Section: Discussionmentioning

confidence: 99%

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Trends in prehospital cervical collar utilization in trauma patients: Closer, but not there yet

Muzyka,

Bradford,

Teixeira

et al. 2023

Academic Emergency Medicine

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ObjectiveThis study aims to assess the change in cervical spine (C‐spine) immobilization frequency in trauma patients over time. We hypothesize that the frequency of unnecessary C‐spine immobilization has decreased.MethodsA retrospective chart review of adult trauma patients transported to our American College of Surgeons–verified Level I trauma center from January 1, 2014, to December 31, 2021, was performed. Emergency medical services documentation was manually reviewed to record prehospital physiology and the application of a prehospital cervical collar (c‐collar). C‐spine injuries were defined as cervical vertebral fractures and/or spinal cord injuries. Univariate and year‐by‐year trend analyses were used to assess changes in C‐spine injury and immobilization frequency.ResultsAmong 2906 patients meeting inclusion criteria, 12% sustained C‐spine injuries, while 88% did not. Patients with C‐spine injuries were more likely to experience blunt trauma (95% vs. 68%, p < 0.001), were older (46 years vs. 41 years, p < 0.001), and had higher Injury Severity Scores (31 vs. 18, p < 0.001). They also exhibited lower initial systolic blood pressures (108 mm Hg vs. 119 mm Hg, p < 0.001), lower heart rates (92 beats/min vs. 97 beats/min, p < 0.05), and lower Glasgow Coma Scale scores (9 vs. 11, p < 0.001). In blunt trauma, c‐collars were applied to 83% of patients with C‐spine injuries and 75% without; for penetrating trauma, c‐collars were applied to 50% of patients with C‐spine injuries and only 8% without. Among penetrating trauma patients with C‐spine injury, all patients either arrived quadriplegic or did not require emergent neurosurgical intervention. The proportion of patients receiving a c‐collar decreased in both blunt and penetrating traumas from 2014 to 2021 (blunt—82% in 2014 to 68% in 2021; penetrating—24% in 2014 to 6% in 2021).ConclusionsUnnecessary C‐spine stabilization has decreased from 2014 to 2021. However, c‐collars are still being applied to patients who do not need them, both in blunt and in penetrating trauma cases, while not being applied to patients who would benefit from them.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Trends in prehospital cervical collar utilization in trauma patients: Closer, but not there yet

Muzyka,

Bradford,

Teixeira

et al. 2023

Academic Emergency Medicine

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Measuring the Implementation Preferences of Emergency Medical Services Clinicians Using Discrete Choice Experiments

Fishe

Smotherman

Burcham

et al. 2023

Prehospital Emergency Care

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Wilderness Medical Society Clinical Practice Guidelines for Spinal Cord Protection: 2024 Update

Hawkins,

Williams,

Bennett

et al. 2024

Wilderness & Environmental Medicine

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The Wilderness Medical Society reconvened an expert panel to update best practice guidelines for spinal cord protection during trauma management. This panel, with membership updated in 2023, was charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in wilderness environments. Recommendations are made regarding several parameters related to spinal cord protection. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks/burdens for each parameter according to American College of Chest Physicians methodology. Key recommendations include the concept that interventions should be goal-oriented (spinal cord/column protection in the context of overall patient and provider safety) rather than technique-oriented (immobilization). An evidence-based, goal-oriented approach excludes the immobilization of suspected spinal injuries via rigid collars or backboards.

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Factors which affect the application and implementation of a spinal motion restriction protocol by prehospital providers in a low resource setting: A scoping review

Cited by 7 publications

References 73 publications

Trends in prehospital cervical collar utilization in trauma patients: Closer, but not there yet

Trends in prehospital cervical collar utilization in trauma patients: Closer, but not there yet

Measuring the Implementation Preferences of Emergency Medical Services Clinicians Using Discrete Choice Experiments

Wilderness Medical Society Clinical Practice Guidelines for Spinal Cord Protection: 2024 Update

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