Neurologic outcomes following the introduction of a policy for using soft cervical collars in suspected traumatic cervical spine injury: A retrospective chart review

Abstract

Objective In trauma patients with potential cervical spine injury, immobilisation with a rigid cervical collar is widely recommended to prevent a secondary spinal cord injury. There is a lack of evidence for the effectiveness of this practice, but increasing evidence for complications from rigid collars. Soft foam collars may mitigate some of these issues and are used in our health service in place of rigid collars in selected patients at risk for traumatic cervical spine injury. The objective of the present study was to describe the neurological outcome of patients according to the cervical stabilisation technique used. Methods A multi‐centre, retrospective, consecutive, case series of all patients assessed for a traumatic cervical spine injury from October 2017 to July 2018 was conducted. Data were obtained by a medical chart review. The primary outcome was the development of a new neurological deficit because of spinal cord injury while in hospital. Results Inter‐rater reliability of data abstraction demonstrated very strong agreement (kappa 0.85, 95% confidence interval 0.80–0.90). Of 2036 patients, 1133 were managed in a soft collar. A new neurological deficit because of spinal cord injury developed in two patients managed in a rigid collar. One case managed in a soft collar was uncertain because of an incomplete baseline neurological examination. Conclusion The use of soft foam cervical collars in patients at risk for a cervical spine injury does not appear to increase the risk for secondary spinal cord injury but larger prospective studies are required before a robust conclusion on safety can be claimed.

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

“…These survey results are also relevant for the use of selective immobilization protocols. A number of prior studies have documented the discrepancy between assessment findings and treatment provided, most often in the case of not applying devices when indicated [20][21][22]. While past research has noted substantial variation in how providers interpret MOIs, [21] and consequently whom they choose to assess, this area of decision-making has not been prospectively quantified.…”

“…Due to the scoring direction of individual questions, its maximum possible score [40] would indicate a high level of skepticism toward the value of treatment (or low level of endorsement), while the minimum [8] would indicate a low level of skepticism (or high level of endorsement). Overall, the median factor score was 26 (IQR: 24-29.75, range [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Internal consistency of each factor was high (Judging MOIs, 0.77 and Treatment Value, 0.76).…”

“…One study, focusing on geriatric patients with confirmed spinal injuries within a single service, reported that the number of patients who received no prehospital SMR rose from 15.5% to 31.6% after the transition to SMR protocols [19]. Another, assessing the shift to soft-collar use in emergency departments (in areas where local EMS used rigid collars), observed that up to one-third of trauma patients met criteria for spinal precautions but received none of any kind in both the hospital and prehospital settings [20]. Auditing the implementation of a prehospital selective immobilization protocol, Domeier et.…”

Is it finally time we stick our neck out?

“…We would like to commend the contribution of Asha et al, who have attempted to address a long-standing knowledge gap with their publication entitled 'Neurologic outcomes following the introduction of a policy for using soft cervical collars in suspected traumatic cervical spine injury: a retrospective chart review'. 1 Spinal immobilisation has been a continual point of conjecture, with current practice dominated by legacy ideologies and perpetual dogma. The routine application of semi-rigid cervical collars has long been a mainstay of contemporary practice, despite no definitive evidence demonstrating its efficacy in preventing secondary spinal cord damage.…”

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

“…Others studies have compared different treatment techniques and found a range of factors and scenarios that influence patient motion apart from the specific device applied, including driving habits, 15,16 extrication, 17 and patient behavior 18,19 . Additional research has examined patient characteristics and outcomes after introducing new guidelines, observing not only substantial undertreatment among patients who met criteria for precautions but also increases in the number of patients with confirmed injuries who received no treatment from emergency medical services (EMS) 20,21 . While a small number of additional studies using high‐level population data have observed no increase in a final diagnosis of spinal cord injury after SMR, 22,23 the prospects of variable practice, ineffective interventions, and patients not receiving the treatment intended for their injury remain a concern.…”