Evidence for the use of spinal collars in stabilising spinal injuries in the pre-hospital setting in trauma patients: a systematic review

Abstract

Purpose Spinal collars were introduced in 1967 into the management of spinal trauma care as it was thought that this technique of immobilisation would prevent any further neurological or spinal damage in high-risk patients. The aim of this systematic review was to determine whether the use of spinal collars in the pre-hospital trauma patient was recommended by published literature. Methods A systematic search of the literature was conducted between 1990 and 2020, screening PubMed, Medline, Science Direct and Google Scholar. The consequent findings were then qualitatively synthesised with the aim of effectively evaluating the evidence to resolve the discrepancy between current practice and literature. Results Of the nine eligible studies, six deemed that spinal collars should not be used in pre-hospital trauma patients with the remaining three reporting uncertainty if spinal collars were best practice. Our results suggest that there is a discrepancy between current guidance and practice in that although the guidelines recommend the use of spinal collars in the pre-hospital setting the majority of the studies were against the use of spinal collars. Importantly, none of the studies reported any benefits of spinal collars. Conclusion Our study shows a disparity between current guidelines and the published literature and warrants further direct research to obtain a more comprehensive view of the use of spinal collars in a pre-hospital setting.

Cervical spine immobilisation following blunt trauma in pre-hospital and emergency care: A systematic review

“…no immobilisation/movement minimisation). However, due to the emerging variation in the methods used to immobilise trauma patients in pre-hospital or emergency care [ 1 , 12 ] and to fully explore cervical immobilisation strategies we also evaluated movement minimisation strategies when compared to no immobilisation (a post hoc change).…”

“…Furthermore meticulous attention to cervical spine management may distract clinicians from treating immediately life-threatening traumatic pathology and prolong on-scene times. This evolving understanding has led some emergency medical services to abandon all or part of cervical spine immobilisation [ 17 ], but there is variation in practice resulting from uncertainty as to its benefits [ 1 , 12 ]. Hence, with this systematic review we aimed to determine if selection of different cervical spine immobilisation practices—during the pre-hospital and emergency department care of patients with possible cervical spine injury—impacts neurological and other outcomes.…”

“…There is also unease that certain patient groups, for example those with ankylosing spondylitis, may suffer neurological deterioration as a result of neck positioning in a rigid collar [11]. It is now thought possible that full cervical spinal immobilisation during pre-hospital and emergency care may cause more harm than benefit, by increasing work of breathing, risk of aspiration (inhaling blood, vomit or other secretions) and development of pressure sores or by worsening concomitant brain injury (through increasing intracranial pressure) [12][13][14][15]. Cervical spine immobilisation undoubtedly increases pain and discomfort after injury and is not tolerated by people with pre-existing cognitive impairment, agitation after injury and distressed children [1,16].…”