Compulsory Use of the Backboard is Associated with Increased Frequency of Thoracolumbar Imaging

Clemency, Brian M.; Tanski, Christopher; Chambers, Jennifer Gibson; O’Brien, Michael; Knapp, Andrew S; Clark, Alexander J.; McGoff, Patrick; Innes, Johanna; Lindstrom, Heather A.; Hostler, David

doi:10.1080/10903127.2017.1413465

Cited by 5 publications

(5 citation statements)

References 44 publications

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“…As previous studies have suggested, patients on an LSB for periods of time report increased pain, tissue breakdown, and respiratory compromise, which led to "false-positive exams for midline vertebral tenderness", 9 and therefore, increased imaging and cost of care. 4,8,12 Clemency et al 12 in 2018 observed that patient charts before and after the implementation of the new SMR protocol demonstrated the decrease in backboard utilization was associated with a decrease in spine imaging in the ED.…”

Section: Discussionmentioning

confidence: 99%

Pre-Hospital Spinal Immobilization: Neurological Outcomes for Spinal Motion Restriction vs. Spinal Immobilization

Nilhas

Helmer

Drake

et al. 2022

kjm

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Introduction. New recommendations for emergency medical services spinal precautions limit long spinal board use to extrication purposes only and are to be removed immediately. Outcomes for spinal motion restriction versus spinal immobilization were studied. Methods. A retrospective chart review of trauma patients was conducted over a 6-month period at a level I trauma center. Injury severity details and neurologic assessments were collected on 277 patients. Results. Upon arrival, 25 (9.0%) patients had a spine board in place. Patients placed on spine boards were more likely to be moderately or severely injured (ISS>15: 36.0% vs. 9.9%, p = 0.001) and more likely to have neurological deficits documented by EMS (30.4% vs. 8.8%, p = 0.01) and the trauma team (29.2% vs. 10.9%, p = 0.02). Conclusions. This study suggests that the long spine board is being properly used for more critically injured patients. Further research is needed to compare neurological outcomes using a larger sample size and more consistent documentation.

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Section: Discussionmentioning

confidence: 99%

Pre-Hospital Spinal Immobilization: Neurological Outcomes for Spinal Motion Restriction vs. Spinal Immobilization

Nilhas

Helmer

Drake

et al. 2022

kjm

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“…Joining these providers in RSEs are those that have long transport times that can attest to the countless patients that were made worse after emesis (that later developed aspiration pneumonia), or their myofascial strain that was compounded by the limited ability to move for extended periods. 34,35 Members of WADEM called for a round-table discussion at the biannual WADEM Congress in Toronto in May 2017 to discuss the continued lack of acceptance of science in RREs hindering the triage and treatment of patients injured in a RSE with potential spinal injuries. 27 A author of this study (JC) lead this round table discussion, with over 50 interested participants from all professional levels of training and experiences from the full breadth of RSEs.…”

Section: Discussionmentioning

confidence: 99%

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

Weinstein

Cuthbertson

Ragazzoni

et al. 2020

Prehosp. Disaster med.

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Abstract Introduction: Emerging evidence is guiding changes in prehospital management of potential spinal injuries. The majority of settings related to current recommendations are in resource-rich environments (RREs), whereas there is a lack of guidance on the provision of spinal motion restriction (SMR) in resource-scarce environments (RSEs), such as: mass-casualty incidents (MCIs); low-middle income countries; complex humanitarian emergencies; conflict zones; and prolonged transport times. The application of Translational Science (TS) in the Disaster Medicine (DM) context was used to develop this study, leading to statements that can be used in the creation of evidence-based clinical guidelines (CGs). Objective: What is appropriate SMR in RSEs? Methods: The first round of this modified Delphi (mD) study was a structured focus group conducted at the World Association for Disaster and Emergency Medicine (WADEM) Congress in Brisbane Australia on May 9, 2019. The result of the focus group discussion of open-ended questions produced ten statements that were added to ten statements derived from Fischer (2018) to create the second mD round questionnaire. Academic researchers and educators, operational first responders, or first receivers of patients with suspected spinal injuries were identified to be mD experts. Experts rated their agreement with each statement on a seven-point linear numeric scale. Consensus amongst experts was defined as a standard deviation ≤1.0. Statements that were in agreement reaching consensus were included in the final report; those that were not in agreement but reached consensus were removed from further consideration. Those not reaching consensus advanced to the third mD round. For subsequent rounds, experts were shown the mean response and their own response for each of the remaining statements and asked to reconsider their rating. As above, those that did not reach consensus advanced to the next round until consensus was reached for each statement. Results: Twenty-two experts agreed to participate with 19 completing the second mD round and 16 completing the third mD round. Eleven statements reached consensus. Nine statements did not reach consensus. Conclusions: Experts reached consensus offering 11 statements to be incorporated into the creation of SMR CGs in RSEs. The nine statements that did not reach consensus can be further studied and potentially modified to determine if these can be considered in SMR CGs in RSEs.

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“…Recent publications challenge the ubiquitous application of cervical collars or the use of spinal boards in the extrication and transportation phase following an MVC [87][88][89][90]. These papers, based on expert opinion and an analysis of 'excess imaging' associated with immobilisation suggest alternative approaches including gentle patient handling techniques and selfextrication [87][88][89][90].…”

Section: Immobilisationmentioning

confidence: 99%

Extrication of patients trapped following a motor vehicle collision: a systematic scoping review of the literature

Nutbeam

2024

Preprint

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BackgroundExtrication is the process of removing injured or potentially injured people from their vehicles. The origin of current extrication techniques and paradigms is largely unknown. An understanding of the historical evidence related to motor vehicle collisions (MVCs), injuries and deaths will provide context for accepted, contemporary, extrication practices.MethodsExtrication related search terms were developed and applied across of range of sources including Clinical and health care data, Trial registries, Grey literature, Academic and specific Transport related sources.Results7089 articles were identified, following review, 170 are included in this qualitative synthesis. Key themes / categories included: Extrication training and principles, Injures, Immobilisation, Care during entrapment, Clinical response type, Vehicle deformity intrusion entrapment, and Extrication.ConclusionThere is a paucity of published evidence to support the current approach to extrication of entrapped patients following an MVC. Focused studies identifying in detail the injures and their sequelae associated with entrapment, the biomechanics of current techniques and ensuring that the patient perspective is captured will enable the development of much needed evidence based multidisciplinary guidance.

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Compulsory Use of the Backboard is Associated with Increased Frequency of Thoracolumbar Imaging

Abstract: A shift from a spinal immobilization protocol to a spinal motion restriction protocol was associated with a decrease in backboard utilization by EMS providers and a decrease in thoracolumbar spine imaging by ED providers.

Cited by 5 publications

References 44 publications

Pre-Hospital Spinal Immobilization: Neurological Outcomes for Spinal Motion Restriction vs. Spinal Immobilization

Pre-Hospital Spinal Immobilization: Neurological Outcomes for Spinal Motion Restriction vs. Spinal Immobilization

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

Extrication of patients trapped following a motor vehicle collision: a systematic scoping review of the literature

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