Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature

Hood, Natalie; Considine, Julie

doi:10.1016/j.aenj.2015.03.003

Cited by 45 publications

(31 citation statements)

References 57 publications

(138 reference statements)

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“…Since then, immobilization has become a standard procedure in emergency medicine [2]; however, a recent study found that 20% of patients suffering from a cervical SCI were not immobilized whatsoever by emergency care providers [4]. A possible explanation is the fact that, over the years, no evidence for the benefit of immobilization for patient outcomes has been obtained from rigorous studies (e.g., randomized controlled trials) [5][6][7]. Furthermore, regardless of the method, immobilization has its disadvantages, such as general patient manipulation, pain, decubitus, and prolonged pre-hospital time [8,9].…”

Section: Introductionmentioning

confidence: 99%

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

Häske

Lefering

Stock

et al. 2020

Eur J Trauma Emerg Surg

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Purpose This study aimed to identify the prevalence and predictors of spinal injuries that are suitable for immobilization. Methods Retrospective cohort study drawing from the multi-center database of the TraumaRegister DGU®, spinal injury patients ≥ 16 years of age who scored ≥ 3 on the Abbreviated Injury Scale (AIS) between 2009 and 2016 were enrolled. Results The mean age of the 145,833 patients enrolled was 52.7 ± 21.1 years. The hospital mortality rate was 13.9%, and the mean injury severity score (ISS) was 21.8 ± 11.8. Seventy percent of patients had no spine injury, 25.9% scored 2–3 on the AIS, and 4.1% scored 4–6 on the AIS. Among patients with isolated traumatic brain injury (TBI), 26.8% had spinal injuries with an AIS score of 4–6. Among patients with multi-system trauma and TBI, 44.7% had spinal injuries that scored 4–6 on the AIS. Regression analysis predicted a serious spine injury (SI; AIS 3–6) with a prevalence of 10.6% and cervical spine injury (CSI; AIS 3–6) with a prevalence of 5.1%. Blunt trauma was a predictor for SI and CSI (OR 4.066 and OR 3.640, respectively; both p < 0.001) and fall > 3 m for SI (OR 2.243; p < 0.001) but not CSI (OR 0.636; p < 0.001). Pre-hospital shock was predictive for SI and CSI (OR 1.87 and OR 2.342, respectively; both p < 0.001), and diminished or absent motor response was also predictive for SI (OR 3.171) and CSI (OR 7.462; both p < 0.001). Patients over 65 years of age were more frequently affected by CSI. Conclusions In addition to the clinical symptoms of pain, we identify ‘4S’ [spill (fall) > 3 m, seniority (age > 65 years), seriously injured, skull/traumatic brain injury] as an indication for increased attention for CSIs or indication for spinal motion restriction.

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Section: Introductionmentioning

confidence: 99%

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

Häske

Lefering

Stock

et al. 2020

Eur J Trauma Emerg Surg

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“…This strategy was adopted by many prehospital medical services worldwide as well as on trauma courses such as Prehospital Trauma Life Support (PHTLS®) and Advanced Trauma Life Support (ATLS®) [2, 3]. This change occurred despite a lack of high-quality study data to suggest clear benefits [4–6]. On the contrary, a growing body of evidence during recent years indicates that the use of the rigid cervical collar and the hard backboard might indeed have harmful effects.…”

Section: Introductionmentioning

confidence: 99%

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

Maschmann

Jeppesen

Rubin

et al. 2019

Scand J Trauma Resusc Emerg Med

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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.

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“…[1] Both the safety and efficacy of traditional SI have come into question in recent years and as a result some emergency medical services (EMS) agencies have deemphasized the use of LSBs and c-collars. [2][3][4][5] These changes have been implemented based on new evidence that highlights the low incidence of spinal cord injury (SCI), potential harm from the application of these devices, [6][7][8][9][10][11][12] and lack of evidence demonstrating any positive effect on mortality, spinal stability, or neurologic injury. [5,13] Several studies have highlighted specific associations between the use of SI devices and predictors of negative outcomes following trauma, including increased intracranial pressure with c-collar use after traumatic brain injury, [14] as well as increased time spent on scene by EMS personnel, decreased intubation success, and decreased respiratory capacity.…”

Section: Introductionmentioning

confidence: 99%

Prehospital Protocols Reducing Long Spinal Board Use Are Not Associated with a Change in Incidence of Spinal Cord Injury

Castro-Marin¹,

Gaither²,

Rice³

et al. 2019

Prehospital Emergency Care

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Introduction: Many EMS agencies have de-emphasized or eliminated the use of long spinal boards (LSB) for patients with possible spinal injury. We sought to determine if implementation of spinal motion restriction (SMR) protocols, which reduce LSB use, was associated with an increase in spinal cord injury (SCI). Methods: This retrospective observational study includes EMS encounters from 1/1/2013 to 12/31/2015 submitted by SMR-adopting ground-based agencies to a state EMS database with hospital discharge data. Encounters were excluded if SMR implementation date was unknown, occurred during a 3-month run-in period, or were duplicates. Study samples include patients with traumatic injury (TI), possible spinal trauma (P-ST), and verified spinal trauma (V-ST) using hospital discharge ICD-9/10 diagnosis codes. The incidence of SCI before and after implementation of SMR was compared using Chi-squared and logistic regression. Results: From 1,005,978 linked encounters, 104,315 unique encounters with traumatic injury and known SMR implementation date were identified with 51,199 cases of P-ST and 5,178 V-ST cases. The incidence of SCI in the pre-SMR and post-SMR interval for each group was: TI, 0.20% vs. 0.22% (p=0.390); P-ST, 0.40% vs. 0.45% (p=0.436); and V-ST, 4.04% vs. 4.37% (p = 0.561). Age and injury severity adjusted odds ratio of SCI in the highest risk cohort of patients with V-ST was 1.097 after SMR implementation (95% CI 0.818-1.472). Conclusion: In this limited study, no change in the incidence of SCI was identified following implementation of SMR protocols. Prospective evaluation of this question is necessary to evaluate the safety of SMR protocols.

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Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature

Abstract: There are no published high-level studies that assess the efficacy of spinal immobilisation in pre-hospital and emergency care settings. Almost all of the current evidence is related to spinal immobilisation is extrapolated data, mostly from healthy volunteers.

Cited by 45 publications

References 57 publications

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

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

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

Prehospital Protocols Reducing Long Spinal Board Use Are Not Associated with a Change in Incidence of Spinal Cord Injury

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