Cervical Spine Motion Restriction After Blunt Trauma

Serigano, Olivia; Riscinti, Matthew

doi:10.1111/acem.14134

Cited by 6 publications

(6 citation statements)

References 15 publications

(14 reference statements)

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“…3,4 Despite widespread adoption of the principles of SMR, practices and specific guidelines vary. The role of the cervical collar, for example, differs widely among jurisdictions, [5][6][7][8][9][10][11] and it remains unclear which devices and procedures are most effective at limiting potentially harmful motion.…”

Section: Introductionmentioning

confidence: 99%

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

McDonald

Kriellaars

Pryce

2023

Academic Emergency Medicine

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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.

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Section: Introductionmentioning

confidence: 99%

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

McDonald

Kriellaars

Pryce

2023

Academic Emergency Medicine

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“…Some, for example, recommend the cervical collar as a critical component of care [7]; others recommend against it, propose a soft (as opposed to rigid) alternative, or forego its use in some situations [8][9][10][11][12]. This and similar questions continue to be debated [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Paramedic attitudes towards prehospital spinal care: a cross-sectional survey

2022

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Background The optimal application of spinal motion restriction (SMR) in the prehospital setting continues to be debated. Few studies have examined how changing guidelines have been received and interpreted by emergency medical services (EMS) personnel. This study surveys paramedics’ attitudes, observations, and self-reported practices around the treatment of potential spine injuries in the prehospital setting. Methods This was a cross-sectional survey of a North American EMS agency. After development and piloting, the final version of the survey contained four sections covering attitudes towards 1) general practice, 2) specific techniques, 3) assessment protocols, and 4) mechanisms of injury (MOI). Questions used Likert-scale, multiple-choice, yes/no, and free-text responses. Exploratory factor analysis (EFA) was used to identify latent constructs within responses, and factor scores were analyzed by ordinal logistic regression for associations with demographic characteristics (including qualification level, gender, and years of experience). MOI evaluations were assessed for inter-rater reliability (Fleiss’ kappa). Inductive qualitative content analysis, following Elo & Kyngäs (2008), was used to examine free-text responses. Results Two hundred twenty responses were received (36% of staff). Raw results indicated that respondents felt that SMR was seen as less important than in the past, that they were treating fewer patients than previously, and that they follow protocol in most situations. The EFA identified two factors: one (Judging MOIs) captured paramedics’ estimation that the presented MOI could potentially cause a spine injury, and another (Treatment Value) reflected respondents’ composite view of the effectiveness, importance, and applicability of SMR. Respondents with advanced life support (ALS) qualification were more likely to be skeptical of the value of SMR compared to those at the basic life support (BLS) level (OR: 2.40, 95%CI: 1.21–4.76, p = 0.01). Overall, respondents showed fair agreement in the evaluation of MOIs (k = 0.31, 95%CI: 0.09–0.49). Content analysis identified tension expressed by respondents between SMR-as-directed and SMR-as-applied. Conclusion Results of this survey show that EMS personnel are skeptical of many elements of SMR but use various strategies to balance protocol adherence with optimizing patient care. While identifying several areas for future research, these findings argue for incorporating provider feedback and judgement into future guideline revision.

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“…3,4 Thishasevolvedduetorecognitionofsomeoftheadverse effects of immobilization as well as limitations to its benefits.Theroleofthecervicalcollaritselfvariesbyjurisdictionanditis not entirely clear which devices and procedures are most effective at reducing potentially harmful spinal motion. [5][6][7][8][9][10][11] Existing research on SMR confirms decreases in the use of long backboards and increases in collar-only treatment. 12-14 Some of this research has observed substantial undertreatment among patients who met criteria for precautions as well as some patients with confirmed injuries who received no treatment from emergency medical services (EMS).…”

mentioning

confidence: 95%

Hot off the press: Prehospital cervical spine immobilization

Bond,

Datta,

Milne

2023

Academic Emergency Medicine

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Pre‐hospital care of patients with potential cervical spine injuries has evolved over time from strict spinal immobilization (SI) with a hard collar and spine board to spinal motion restriction (SMR) with more variable use of cervical collars and patient positioning. There is limited research describing how these changes have been implemented. This study describes and analyzes the practice of SI/SMR in an urban Canadian Emergency Medical Service. We provide critical analysis of the article and summarize the social media discussion and a podcast in which the authors discuss their work.

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Cervical Spine Motion Restriction After Blunt Trauma

Cited by 6 publications

References 15 publications

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

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

Paramedic attitudes towards prehospital spinal care: a cross-sectional survey

Hot off the press: Prehospital cervical spine immobilization

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