Spinal immobilisation for unconscious patients with multiple injuries

Morris, C.; McCoy, É. P.; Lavery, G.G.

doi:10.1136/bmj.329.7464.495

Cited by 78 publications

(35 citation statements)

References 35 publications

(46 reference statements)

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“…52,53 Performing a tracheotomy should probably not be regarded as a risk factor per se, but rather as a marker for the severity of the patient's clinical state. Other therapeutic actions, such as wearing a neck brace during the acute stage of polytrauma, have been associated with the onset of PU, 54 but no study is SCI-specific for this variable.…”

Section: Discussionmentioning

confidence: 99%

Pressure ulcer risk factors in persons with SCI: part I: acute and rehabilitation stages

Gélis

Dupeyron

Legros³

et al. 2008

Spinal Cord

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Background: Pressure ulcers (PUs) are a common complication following a spinal-cord injury (SCI). Good prevention requires identifying the individuals at risk for developing PUs. Risk assessment scales used nowadays were designed on pathophysiological concepts and are not SCI-specific. Recently, an epidemiological approach to PU risk factors has been proposed to design an SCI-specific assessment tool. The first results seem quite disappointing, probably becuase of the level of evidence of the risk factors used. Objective: To determine PU risk factors correlated to the patients with SCI, medical care management during the acute as well as in the rehabilitation and chronic stages. This first part focuses on identifying the risk factors during the acute and rehabilitation stages. Materials and methods: Systematic review of the literature. Results: Six studies met our inclusion criteria. The risk factors during the acute stage of an SCI are essentially linked to care management and treatment modalities. There is insufficient evidence to make a recommendation on medical risk factors, except for low blood pressure on admission to the Emergency Room, with a moderate level of evidence. Regarding the rehabilitation stage, no study was deemed relevant. Discussion and conclusions: Additional observational studies are needed, for both the acute and rehabilitation stages, to improve this level of evidence. However, this systematic review unveiled the need for a carefully assessed t care management and the related practices, especially during the acute stage of an SCI.

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Section: Discussionmentioning

confidence: 99%

Pressure ulcer risk factors in persons with SCI: part I: acute and rehabilitation stages

Gélis

Dupeyron

Legros³

et al. 2008

Spinal Cord

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“…Often adequate monitoring cannot be provided in the MRI-unit. Additionally, the relatively large amount of time needed for data acquisition (approximately 30 min) restricts this diagnostic method to special cases, where neurologic symptoms are present without any lesions of the spine visualized by CT [7,8,10,[24][25][26].…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, regions often injured as the junction C7/TH1 are often visualized incompletely despite optimized circumstances of examination like traction on both arms of the patient. Additionally, this examination bears the risk of damage to the spinal cord if not performed securely and therefore should be restricted to the experienced surgeons [8,9,24].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis, Timing and Treatment of Cervical Spine Injuries in Polytraumatized Patients

Saman

Laurer

Maier

et al. 2007

Eur J Trauma Emerg Surg

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Treatment of polytrauma patients has been discussed extensively during the past decades. Management in the prehospital phase, on admission, and in the early postoperative/ICU-period has to refer to injury severity, priority of injuries, and likelihood of development of multi organ failure. Cervical spine injuries are reported in 4-34% of polytrauma cases. Securing the cervical spine by a hard collar is one of the basic procedures in the prehospital phase. Different strategies of assessing the cervical spine are still discussed controversially. Since plain radiographs, CT-scan, MRI, and flexion/extension fluoroscopy still play a role in early diagnosis of cervical spine injury, we present an analysis of cervical spine injuries in our multiple trauma patients to elucidate our algorithm. We reviewed our data between January 2003 and December 2006 concerning epidemiology, diagnosis and treatment of cervical spine injury in polytrauma patients. Multislice-CT (MSCT) or Multidetector-CT was used as standard diagnostic procedures in the polytraumatized patient. In 97% of patients, CT-scanning showed to be a reliable tool in detecting injuries of the cervical spine. Only in two patients (3%), additional MRI lead to a change in treatment strategy. Of 66 polytraumatized patients with significant cervical spine injury, 25 (37.9%) received surgical treatment within 24 h. Sixteen patients (24.2%) were treated surgically after stabilization on ICU. There was a better outcome concerning length of hospitalization in the "day-onesurgery" group. We consider MSCT as standard approach towards diagnosis of cervical spine injury in polytrauma patients. MRI and flexion/extension fluoroscopy can give additional information in selected cases.

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“…The risks of prolonged immobilisation, beyond 48-72 h, are poorly appreciated and exceed those of a serious missed cervical spine injury [1,2]. Whilst most clinicians are cognisant and have experience of the many complications of 'spinal precautions' and immobilisation with collar complications, there is paradoxically sparse literature available on this topic.…”

Section: Complications Of 'Spinal Precautions': Prolonged Immobilisatmentioning

confidence: 97%

“…1 the spine of the obtunded blunt trauma patient (OBTP) who is likely to remain unevaluable. Previous reviews and practice guidelines on this topic were produced in 2004, and adopted by the United Kingdom Intensive Care Society [1,2]. Since 2004 there have been three meta-analyses on the subject [3][4][5] and an update from the Eastern Association of Trauma (EAST) [6].…”

Section: Background and Limitations Of The Current Paradigmmentioning

confidence: 99%

Clinical review: spinal imaging for the adult obtunded blunt trauma patient: update from 2004

Plumb

Morris

2012

Intensive Care Med

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Spinal immobilisation for unconscious patients with multiple injuries

Cited by 78 publications

References 35 publications

Pressure ulcer risk factors in persons with SCI: part I: acute and rehabilitation stages

Pressure ulcer risk factors in persons with SCI: part I: acute and rehabilitation stages

Diagnosis, Timing and Treatment of Cervical Spine Injuries in Polytraumatized Patients

Clinical review: spinal imaging for the adult obtunded blunt trauma patient: update from 2004

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