Patterns of change in prehospital spinal motion restriction: A retrospective database review

Abstract

Background Acute management of trauma patients with potential spine injuries has evolved from uniform spinal immobilization (SI) to spinal motion restriction (SMR). Little research exists describing how these changes have been implemented. This study aims to describe and analyze the practice of SMR in one emergency medical services (EMS) agency over the time frame of SMR adoption. Methods This was a retrospective database review of electronic patient care reports from 2009 to 2020. The effects of key practice changes (revised documentation and a collar‐only treatment option) were analyzed in an interrupted time series using the rate of SI/SMR as the primary outcome. Secondary outcomes included patient age, sex, acuity, mechanism of injury, treatment provided, cervical collar size, and positioning. These were assessed for changes from year to year by Poisson regression. Associations between patient and treatment characteristics were investigated with binomial logistic regression. Results There were 25,747 instances of SI/SMR included. Among all patients, the median age was 40 (interquartile range 24–56), 58% (14,970) were male, and 20% (5062) were high‐acuity. The rate of SI/SMR declined from 31.2 to 12.7 treatments per 100 trauma calls per month. The proportion of high‐acuity patients increased by 9.6% per year on average (95% CI 8.7%–10.0%). When first available, collar‐only treatment was provided to 47% of patients, rising by 6.3% per year (95% CI 3.2%–9.5%) to 60% in 2020. Collar‐only treatment (compared to board‐and‐collar) was more likely to be applied to low‐acuity patients (as compared to high): odds ratio 3.01 (95% CI 2.64–3.43). Conclusions This study shows decreasing SI/SMR treatment and changing patient and practice characteristics. These patterns of care cannot be attributed solely to formal protocol changes. Similar patterns and their possible explanations should be investigated elsewhere.

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

“…However, a few studies addressing this subject have consistently uncovered a slight decline in the use of SMR techniques 19,20 . In a 2023 analysis of prehospital SMR patterns in the United States, however, this declining trend was deemed to extend beyond mere protocol modifications, suggesting a more complex underlying shift in practice 21 . Largely, this phenomenon of recognizing misuse of c‐collars is physician/center‐driven and there is a disconnect, or perhaps a delay in implementation, in EMS practice.…”

“…19,20 In a 2023 analysis of prehospital SMR patterns in the United States, however, this declining trend was deemed to extend beyond mere protocol modifications, suggesting a more complex underlying shift in practice. 21 Largely, this phenomenon of recognizing misuse of c-collars is physician/center-driven and there is a disconnect, or perhaps a delay in implementation, in EMS practice. This study further highlights these discrepancies between the literature and EMS guidelines; c-collars are increasingly being advised against in the literature and, despite some trends of deceased use, continue to be widely utilized in practice.…”

Restrição Do Movimento Da Coluna: Uma Análise Do Conhecimento Dos Profissionais De Enfermagem

“…Outro estudo retrospectivo, abrangendo os anos de 2009 a 2020, destacou que a taxa de imobilização/restrição do movimento da coluna diminuiu sua implementação de 31,2 para 12,7 por 100 chamados de trauma por mês. Ainda, demonstrou uso mais seletivo dos protocolos, com adoção de prancha longa para pacientes com sinais de gravidade, enquanto para pacientes menos graves, apenas utilização de colar cervical, após atualização dos critérios de avaliação 16 .…”

Restricted Movement of the Spine: An Analysis of the Knowledge of Nursing Professionals

“…Another retrospective study, covering the years 2009 to 2020, highlighted that the rate of immobilization/restriction of movement of the spine decreased its implementation from 31.2 to 12.7 per 100 trauma calls per month. It also demonstrated a more selective use of protocols, with the adoption of a longboard for patients with signs of severity, while for less severe patients, only the use of a cervical collar, after updating the assessment criteria 16 .…”