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

Oteir, Alaa O; Smith, Karen; Stoelwinder, Johannes Uiltje; Middleton, James; Jennings, Paul

doi:10.1016/j.injury.2014.12.032

Cited by 48 publications

(25 citation statements)

References 37 publications

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“…A total of 69 original papers were selected for full text reading of which 16 were considered eligible for inclusion into our literature base (Additional file 2). In addition, six systematic reviews were identified and included (Additional file 3) [42, 44, 45, 57–59]. …”

Section: Resultsmentioning

confidence: 99%

The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury

Kornhall

Jørgensen

Brommeland

et al. 2017

Scand J Trauma Resusc Emerg Med

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The traditional prehospital management of trauma victims with potential spinal injury has become increasingly questioned as authors and clinicians have raised concerns about over-triage and harm. In order to address these concerns, the Norwegian National Competence Service for Traumatology commissioned a faculty to provide a national guideline for pre-hospital spinal stabilisation. This work is based on a systematic review of available literature and a standardised consensus process. The faculty recommends a selective approach to spinal stabilisation as well as the implementation of triaging tools based on clinical findings. A strategy of minimal handling should be observed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-016-0345-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury

Kornhall

Jørgensen

Brommeland

et al. 2017

Scand J Trauma Resusc Emerg Med

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“…Although this is rare with an incidence estimated between 0.06% and 0.5%, 2 the potentially devastating outcome from a secondary cervical cord injury has been the main concern mandating rigid collars as a standard of care in many trauma systems around the world. However, this intervention is based on consensus and opinion rather than scientific evidence, 3–5 with the effectiveness questioned by some authors 1,6,7 . Rigid collars can lead to complications including pain, pressure areas, increased intracranial pressure, impaired ventilation, aspiration and masking of neck/occipital injuries 3–5,7–11 .…”

Section: Introductionmentioning

confidence: 99%

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

Asha

Curtis

Healy

et al. 2020

Emerg Medicine Australasia

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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.

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“…Spinal immobilisation with a neck collar may lead to airway management difficulty and therefore delay tracheal intubation or increase the risk of pulmonary aspiration [1, 2, 5, 11, 13]. The insertion of a central venous catheter can also be much more difficult.…”

Section: Discussionmentioning

confidence: 99%

“…Spinal immobilisation of blunt trauma victims with potential spinal cord injury has been considered standard of care for several decades. Inadequate management of spinal injury may cause neurological deficits and spinal stabilisation has therefore been considered crucial for preventing such secondary injuries [1, 2].…”

Section: Introductionmentioning

confidence: 99%

“…Many researchers have, however, raised concerns about immobilisation and questioned its efficacy, the risk of over-triage and potential harmful effects as the evidence of the benefits of spinal immobilisation has been limited [1, 2]. Furthermore, several studies have identified complications related to immobilisation, such as tissue ischemia, pressure ulcers and decreased lung volumes [3–5].…”

Section: Introductionmentioning

confidence: 99%

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Patient experience of spinal immobilisation after trauma

Ottosen

Steinmetz

Larsen

et al. 2019

Scand J Trauma Resusc Emerg Med

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Background Spinal immobilisation of blunt trauma victims with potential spinal cord injury is considered standard of care. The traditional management has, however, been increasingly questioned and concerns about harm have been raised. Few studies have described the perspective of the trauma patient regarding the spinal immobilisation. The objective of this study was therefore to evaluate the patient experience of immobilisation after trauma. Methods We prospectively screened adult trauma patients admitted to a level 1 trauma centre for eligibility. We included adult trauma patients who had been, and remembered being, immobilised for spinal protection with a cervical collar and a spine board prehospitally or upon arrival at the trauma centre. A semi-structured interview was conducted 2 to 72 h after admission either in person or by telephone. Results One hundred and fourteen patients were eligible for inclusion based on the patient charts. Out of 98 patients assessed for participation, 48 (49%) had no memory of being immobilised. We thus included 50 patients with a median age of 37 years (IQR: 26–60) of whom 38 (76%) were men. The median injury severity score was 9 (IQR: 3–15) and the median time with a cervical collar from initial application to in-hospital removal or until the interview was given was 91 min (IQR: 72–136). Nineteen patients (38%) reported discomfort and 12 patients (24%) experienced pain related to the immobilisation. Forty patients (80%) reported a sense of protection related to the immobilisation. Conclusion Discomfort related to spinal immobilisation was reported in 38% of trauma patients. However, a sense of protection was a recurring theme in 80% of the trauma patients, who recalled being immobilised. Nearly half of the awake trauma patients had no memory of being immobilised.

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

Cited by 48 publications

References 37 publications

The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury

The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury

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

Patient experience of spinal immobilisation after trauma

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