Pre-hospital spinal immobilisation: an initial consensus statement

Connor, D; Greaves, Ian; Porter, Keith; Bloch, Mark

doi:10.1136/emermed-2013-203207

Cited by 69 publications

(69 citation statements)

References 15 publications

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“…Guidelines recommend a thorough evaluation of the patient with SCI and high-risk presentation (e.g., male sex, age < 45 years, impairment on the Glasgow Coma Scale, and chest injury from falls > 10 feet or due to motor vehicle accidents > 45 miles per hour). 18 Computed tomography is the first-line imaging for the patient with SCI and polytrauma, because it provides rapid imaging with improved visualization of bony fractures. Vertebral column instability secondary to ligamentous injury should be evaluated, and flexor and extensor views should be obtained if the cervical spine is involved.…”

Section: Imaging Methodsmentioning

confidence: 99%

Update on critical care for acute spinal cord injury in the setting of polytrauma

Yue

Winkler

Rick

et al. 2017

Neurosurgical Focus

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Traumatic spinal cord injury (SCI) often occurs in patients with concurrent traumatic injuries in other body systems. These patients with polytrauma pose unique challenges to clinicians. The current review evaluates existing guidelines and updates the evidence for prehospital transport, immobilization, initial resuscitation, critical care, hemodynamic stability, diagnostic imaging, surgical techniques, and timing appropriate for the patient with SCI who has multisystem trauma. Initial management should be systematic, with focus on spinal immobilization, timely transport, and optimizing perfusion to the spinal cord. There is general evidence for the maintenance of mean arterial pressure of > 85 mm Hg during immediate and acute care to optimize neurological outcome; however, the selection of vasopressor type and duration should be judicious, with considerations for level of injury and risks of increased cardiogenic complications in the elderly. Level II recommendations exist for early decompression, and additional time points of neurological assessment within the first 24 hours and during acute care are warranted to determine the temporality of benefits attributable to early surgery. Venous thromboembolism prophylaxis using low-molecular-weight heparin is recommended by current guidelines for SCI. For these patients, titration of tidal volumes is important to balance the association of earlier weaning off the ventilator, with its risk of atelectasis, against the risk for lung damage from mechanical overinflation that can occur with prolonged ventilation. Careful evaluation of infection risk is a priority following multisystem trauma for patients with relative immunosuppression or compromise. Although patients with polytrauma may experience longer rehabilitation courses, long-term neurological recovery is generally comparable to that in patients with isolated SCI after controlling for demographics. Bowel and bladder disorders are common following SCI, significantly reduce quality of life, and constitute a focus of targeted therapies. Emerging biomarkers including glial fibrillary acidic protein, S100β, and microRNAs for traumatic SCIs are presented. Systematic management approaches to minimize sources of secondary injury are discussed, and areas requiring further research, implementation, and validation are identified.

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Section: Imaging Methodsmentioning

confidence: 99%

Update on critical care for acute spinal cord injury in the setting of polytrauma

Yue

Winkler

Rick

et al. 2017

Neurosurgical Focus

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“…In 1998, Hauswald concluded from biomechanical studies that immobilising the spine is unlikely to prevent further spinal cord damage to the patient. [3] Local oedema and hypoxia were more likely to be contributors to secondary neurological damage. These are time dependent factors, potentially exacerbated by the delays to definitive care involved in immobilising the patient.…”

Section: Pre-hospital Spinal Immobilisationmentioning

confidence: 99%

“…These are time dependent factors, potentially exacerbated by the delays to definitive care involved in immobilising the patient. [3] Since these studies were released, controversy has continued to grow surrounding the procedure, with greater documentation of adverse effects of its use. [2] This has led to clinicians in the U.K. reflecting upon how phSI should be implicated in modern care.…”

Section: Pre-hospital Spinal Immobilisationmentioning

confidence: 99%

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The definite risks and questionable benefits of liberal pre-hospital spinal immobilisation

Purvis

Carlin

Driscoll

2017

The American Journal of Emergency Medicine

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Intro:The routine practice of pre-hospital spinal immobilisation (phSI) for patients with suspected spinal injury has existed for decades. However, the controversy surrounding it resulted in the 2013 publication of a Consensus document by the Faculty of Pre-Hospital Care. The question remains as to whether the quality of evidence in the literature is sufficient to support the Consensus guidelines. This critical review aims to determine the validity of current recommendations by balancing the potential benefits and side effects of phSI. Method.A review of the literature was carried out by two independent assessors using Medline, PubMed, EMBASE and the Cochrane Library databases. Manual searches of related journals and reference lists were also completed. The selected body of evidence was subsequently appraised using a checklist derived from SIGN and CASP guidelines, as well as Crombie's guide to critical appraisal.

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Spinal and Neurological Trauma

Sinha

Knight

2022

Textbook of Acute Trauma Care

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Pre-hospital spinal immobilisation: an initial consensus statement

Cited by 69 publications

References 15 publications

Update on critical care for acute spinal cord injury in the setting of polytrauma

Update on critical care for acute spinal cord injury in the setting of polytrauma

The definite risks and questionable benefits of liberal pre-hospital spinal immobilisation

Spinal and Neurological Trauma

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