New clinical guidelines on the spinal stabilisation of adult trauma patients – consensus and evidence based

Abstract

Traumatic spinal cord injury is a relatively rare injury in Denmark but may result in serious neurological consequences. For decades, prehospital spinal stabilisation with a rigid cervical collar and a hard backboard has been considered to be the most appropriate procedure to prevent secondary spinal cord injuries during patient transportation. However, the procedure has been questioned in recent years, due to the lack of high-quality studies supporting its efficacy. A national interdisciplinary task force was therefore established to provide updated clinical guidelines on prehospital procedures for spinal stabilisation of adult trauma patients in Denmark. The guidelines are based on a systematic review of the literature and grading of the evidence, in addition to a standardised consensus process. This process yielded five main recommendations: A strong recommendation against spinal stabilisation of patients with isolated penetrating trauma; a weak recommendation against the prehospital use of a rigid cervical collar and a hard backboard for ABCDE-stable patients; and a weak recommendation for the use of a vacuum mattress for patient transportation. Finally, our group recommends the use of our clinical algorithm to ensure good clinical practice. Electronic supplementary material The online version of this article (10.1186/s13049-019-0655-x) contains supplementary material, which is available to authorized users.

Epidemiology and predictors of traumatic spine injury in severely injured patients: implications for emergency procedures

“…The most well-known decision-making aids for spinal immobilization are the NEXUS criteria and the Canadian C-Spine Rule (CCSR), and, in Europe, the E.M.S. IMMO protocol and the Scandinavian recommendations [10][11][12][13]. All of these decision rules include possible predictors that should detect an increased probability of spinal injury in trauma patients.…”

Early Management of Cervical Spine Trauma: WFNS Spine Committee Recommendations

“…About 3%-25% of secondary spinal cord injuries occur either during transit or early management. 1,14 The idea of reducing the risk of neurologic deterioration by immobilizing the patients using a rigid cervical collar and a hard backboard was first postulated in the 1960s. Since then, this strategy was implemented and remained an integral part of many EMS worldwide.…”

“…Since then, this strategy was implemented and remained an integral part of many EMS worldwide. 1,11 Prehospital spinal immobilization is a prioritized procedure in the Advanced Trauma Life Support (ATLS) guidelines from the American College of Surgeons 15 and in the Prehospital Trauma Life Support (PHTLS ® ) guidelines from the National Association of Emergency Medical Technicians. 16 These guidelines dominate the field of EMS care, and are utilized in almost 60 countries.…”

“…However, the repercussion of traumatic SCI may be drastic and lead to substantial handicap. 1 SCI can be a severe pathology that results in motor and sensitive involvement and generates a significant impact on the patient's psychosocial, mental, and social life. Learning epidemiology, reasons of trauma would lead to prepare preventive measures.…”

A T2 Translational Science Modified Delphi Study: Spinal Motion Restriction in a Resource-Scarce Environment

“…The application of this approach would be reasonable to take priority over a lengthy SMR process. 45 However, the experts did not reach consensus without an explanation; though similar to penetrating trauma, this may not be in the practice of certain experts and can be remedied during the CGs creation, education, and exercise T3 phase. The lack of consensus to remove SMR when faced with prolonged transport and that first responders can develop reasonable SMR strategies with inexpensive readily available materials may require more detailed CGs with dedicated education and exercises.…”