S Pinal I Mmobilization in the F Ield : C Linical C Learance C Riteria and I Mplementation

Hankins, Daniel; Rivera‐Rivera, Edgardo J.; Ornato, Joseph P.; Swor, Robert A.; Blackwell, Thomas H.; Domeier, Robert M.

doi:10.1080/10903120190940416

Cited by 30 publications

(23 citation statements)

References 15 publications

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“…This practice is based on the assumption that immobilisation minimises spinal movement [14,15], reduces risk of secondary injuries [15,16], and facilitates extrication and transport [15]. There is emerging evidence, however, that spinal immobilisation may be associated with adverse effects, including increased risk of respiratory compromise [15,17,18], back and neck pain [17][18][19][20][21], pressure sores [22,23], and increased intracranial pressure [24]. Moreover, it may lead to additional cost and scene time [17], as well as the possible risk of dropping the immobilised patient by prehospital providers in difficult extrication situations when traversing narrow and unstable paths [17,22].…”

Section: Introductionmentioning

confidence: 99%

Should suspected cervical spinal cord injury be immobilised?: A systematic review

Oteir

Smith

Stoelwinder

et al. 2015

Injury

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Section: Introductionmentioning

confidence: 99%

Should suspected cervical spinal cord injury be immobilised?: A systematic review

Oteir

Smith

Stoelwinder

et al. 2015

Injury

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“…208 Altogether, there is a wide range of algorithms based on different clinical criteria for clearance of the cervical spine in the prehospital setting. [87][88][89][90][91]205,[208][209][210][211][212][213][214][215][216][217][218] Patients with reduced consciousness Patients with reduced consciousness have a higher prevalence of CSIs, and cervical spine clearance in such patients is not as clear cut as in conscious patients.…”

mentioning

confidence: 99%

Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review

Sundstrøm

Asbjørnsen

Habiba

et al. 2014

Journal of Neurotrauma

144

115

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The cervical collar has been routinely used for trauma patients for more than 30 years and is a hallmark of state-of-the-art prehospital trauma care. However, the existing evidence for this practice is limited: Randomized, controlled trials are largely missing, and there are uncertain effects on mortality, neurological injury, and spinal stability. Even more concerning, there is a growing body of evidence and opinion against the use of collars. It has been argued that collars cause more harm than good, and that we should simply stop using them. In this critical review, we discuss the pros and cons of collar use in trauma patients and reflect on how we can move our clinical practice forward. Conclusively, we propose a safe, effective strategy for prehospital spinal immobilization that does not include routine use of collars.

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“…These workers prospectively showed that these criteria were not affected by mechanism of injury, missing 3% and 6% of injuries in high and low risk groups, respectively [93]. These two studies prompted the production of practice guidelines for selectively immobilizing trauma victims during transfer [94,95], and clinical criteria identified 280 ⁄ 295 (94.9%) of cervical injuries [33]. Available evidence suggests that applying prehospital clinical criteria may raise suspicion of approximately 90% of spinal injuries but has little capacity to identify individual cases, and carries an unacceptable false negative rate of 10%.…”

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confidence: 99%

Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening

Morris¹,

McCoy²

2004

Anaesthesia

106

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SummaryCervical spine injury occurs in 5-10% of cases of blunt polytrauma. A missed or delayed diagnosis of cervical spine injury may be associated with permanent neurological sequelae. However, there is no consensus about the ideal evaluation and management of the potentially injured cervical spine and, despite the publication of numerous clinical guidelines, this issue remains controversial. In addition, many studies are limited in their application to the obtunded or unconscious trauma victim. This review will provide the clinician managing unconscious trauma victims with an assessment of the actual performance of clinical examination and imaging modalities in detecting cervical spine and isolated ligamentous injury, a review of existing guidelines in light of the available evidence, relative risk estimates and a proposed management scheme. Cervical spine and associated spinal cord injury significantly affect the individual's functional capacity and quality of life, and carry significant implications for society. It was estimated in 1988 that a 27-year-old rendered tetraparetic would consume US$ 1 million for lifetime care and, with 721 tetraparetic individuals per million of the population, the total aggregate costs were an estimated US$ 5.6 billion per year [1]. In America, cervical, thoracic and lumbar vertebral fractures occur with an incidence of 50 000 per year [2], and cervical spine injury has an annual incidence of 5-10 000 cases per year [3,4]. More recent estimates suggest an incidence of 8-10 000 spinal cord injuries per year, of which 55% are cervical [5]. In the UK, there are approximately 1000 new cases of cervical cord injury each year [6]. Cervical spine injury complicates blunt polytrauma in 2-12% of cases [7][8][9]. However, several larger reviews that include 29 000 blunt trauma victims, and additional prospectively gathered data, demonstrate a generally lower incidence (2.0-5.2%) [10][11][12][13].The presence of a severe head injury increases the relative risk of a cervical spine injury, possibly by 8.5 times, and a focal neurological deficit by 58 times [14]. A Glasgow Coma Scale (GCS) score of < 8 is associated with a 50% increase in the incidence of cervical spine injury to 7.8% [15]. Similarly, Demetriades et al.[16] have shown that although the incidence of cervical spine injury in trauma victims with a GCS score of 13-15 was only 1.4%; this increased to 10.2% if GCS was < 8. 'Primary' cervical spine injury may be associated with head injury in 24-35% of cases [10,[16][17][18][19][20], and among polytrauma victims requiring cervical spine stabilization surgery, only 74% suffered an isolated injury [21]. The prognosis in patients suffering both head and cervical injury is typically poor, with approximately 25% being discharged to a dedicated nursing facility with little prospect of recovery [22]. Traumatic brain injury has a UK incidence of 100 per 100 000 population [23], typically among young, working age males, and therefore the combined consequences of brain and spine injury both ...

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S Pinal I Mmobilization in the F Ield : C Linical C Learance C Riteria and I Mplementation

Cited by 30 publications

References 15 publications

Should suspected cervical spinal cord injury be immobilised?: A systematic review

Should suspected cervical spinal cord injury be immobilised?: A systematic review

Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review

Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening

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