Patient experience of spinal immobilisation after trauma

Abstract

Background Spinal immobilisation of blunt trauma victims with potential spinal cord injury is considered standard of care. The traditional management has, however, been increasingly questioned and concerns about harm have been raised. Few studies have described the perspective of the trauma patient regarding the spinal immobilisation. The objective of this study was therefore to evaluate the patient experience of immobilisation after trauma. Methods We prospectively screened adult trauma patients admitted to a level 1 trauma centre for eligibility. We included adult trauma patients who had been, and remembered being, immobilised for spinal protection with a cervical collar and a spine board prehospitally or upon arrival at the trauma centre. A semi-structured interview was conducted 2 to 72 h after admission either in person or by telephone. Results One hundred and fourteen patients were eligible for inclusion based on the patient charts. Out of 98 patients assessed for participation, 48 (49%) had no memory of being immobilised. We thus included 50 patients with a median age of 37 years (IQR: 26–60) of whom 38 (76%) were men. The median injury severity score was 9 (IQR: 3–15) and the median time with a cervical collar from initial application to in-hospital removal or until the interview was given was 91 min (IQR: 72–136). Nineteen patients (38%) reported discomfort and 12 patients (24%) experienced pain related to the immobilisation. Forty patients (80%) reported a sense of protection related to the immobilisation. Conclusion Discomfort related to spinal immobilisation was reported in 38% of trauma patients. However, a sense of protection was a recurring theme in 80% of the trauma patients, who recalled being immobilised. Nearly half of the awake trauma patients had no memory of being immobilised.

Tratamento pré-hospitalar da dor traumática aguda: um estudo observacional

“…A imobilização é uma medida ou técnica importante utilizada na prevenção de lesões causadas por traumas, mas é também responsável por elevadas taxas de desconforto. (24,25) É uma medida não farmacológica frequentemente recomendada para o alívio da dor (1) , embora a bibliografia disponível não tenha ainda sido capaz de demonstrar a sua eficácia (26).…”

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

“…Professional associations through the years have supported the science and were not successful to achieve widespread acceptance. 29 The RREs with the highest level of trained first responders, replete with spinal immobilization supplies, have maintained the practice of spinal immobilization with the majority of patients fully expecting to be placed in a rigid cervical collar, strapped to a long board for transport to the emergency department, on occasion enduring lengthy periods uncomfortably flat, as this was what they were told was best for them, 30 not only by the providers, but images on screens and billboards small and large. But what of the prehospital and hospital providers that practice in low-or middle-income countries, complex humanitarian emergencies, or conflict zones?…”

European Resuscitation Council Guidelines 2021: First aid

“…2,3 This recommendation was made in 2015 and upheld in 2020 as the Task Force felt that it was consistent with the first aid principle of preventing further harm compared with the potential benefits of applying a cervical collar. 4,5 Adverse effects have been reported from the use of cervical collars such as delayed transportation to definitive care, 192,193 patient discomfort and pain, 194 raised intracranial pressure 195,196 and reduced tidal volume. 197 In 2019 the First Aid Task Force undertook an extensive scoping review of cervical spinal motion restriction.…”