The Evidence for Spinal Immobilization: An Estimate of the Magnitude of the Treatment Benefit

Sundheim, Scott M.; Cruz, Michael J.

doi:10.1016/j.annemergmed.2006.02.034

Cited by 11 publications

(3 citation statements)

References 13 publications

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“…With an estimate of having to immobilize between 625 and 3333 patients to prevent one exacerbation of injury, larger prospective studies are required before a robust conclusion on safety can be confirmed. 16 In conclusion, there were no differences in the rates of SCI, pressure sores or hospital‐acquired pneumonia after a change of prehospital practice from semi‐rigid collars to soft collars. There were more CT scans of the cervical spine performed among patients managed with a soft collar, but also a higher rate of clearance of the cervical spine in the ED.…”

Section: Discussionmentioning

confidence: 79%

Change from semi‐rigid to soft collars for prehospital management of trauma patients: An observational study

Mitra,

Bernard,

Yankoff

et al. 2024

JACEP Open

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ObjectivesProtection of the cervical spine is recommended following multisystem injury. In 2021, Ambulance Victoria changed clinical practice guidelines to apply soft collars instead of semi‐rigid collars for suspected cervical spine injury. The aim of this study was to describe associated changes in imaging practices and diagnoses of pressure sores, hospital acquired pneumonia, and spinal cord injury.MethodsA retrospective pre‐ and postintervention study was conducted including all consecutive patients that presented to an adult major trauma center in Melbourne, Australia with a cervical collar placed by emergency medical services over two 3‐month periods.ResultsThere were 1762 patients included. A computed tomography (CT) of the cervical spine was performed in 795 (88.4%) patients in the semi‐rigid collar period and 810 (93.8%) in the soft collar period (p = 0.001). Soft collars were associated with higher rates of clearance of the cervical spine in the emergency department (ED) (odds ratio [OR] 4.14; 95% confidence interval [CI]: 3.36–5.09). There were no differences in diagnosis of pressure sores (0.11% vs. 0.23%, p = 0.97) or hospital acquired pneumonia (2.0% vs. 2.7%; p = 0.44) or cervical spinal cord injury (0.45% vs. 0.81%; p = 0.50).ConclusionsFollowing a change from prehospital semi‐rigid collars to soft collars, more patients were investigated with a CT scan and more frequent clearance of the cervical spine occurred in the ED. There were no differences in the rates of spinal cord injuries, pressure sores or hospital acquired pneumonia, but the study was underpowered to detect significant differences. The practice of soft collars for prehospital care of patients with suspected neck injury requires ongoing surveillance.

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Section: Discussionmentioning

confidence: 79%

Change from semi‐rigid to soft collars for prehospital management of trauma patients: An observational study

Mitra,

Bernard,

Yankoff

et al. 2024

JACEP Open

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“…As enumerated in a letter to the editor in response to a 2006 summary of this Cochrane review, one non–peer‐reviewed estimate of NNT for spinal immobilization to prevent secondary neurologic injury was reported to be between 625 and 3,333 12 . This was calculated based on three case series published 32 to 64 years ago 13–15 and assumes that all episodes of deterioration were both directly caused by movement during transport and preventable by immobilization.…”

Section: Caveatsmentioning

confidence: 99%

Cervical Spine Motion Restriction After Blunt Trauma

Serigano

Riscinti

2020

Academic Emergency Medicine

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“…These risks must be considered in the light of the fact that the best evidence to date suggests that the number needed to treat (NNT) with spinal immobilastion in order to prevent one secondary neurological injury lies between 625 and 3,333 trauma patients. 24…”

Section: Review Articlesmentioning

confidence: 99%

Clearing the Spine in the Unconscious Trauma Patient: An Update

Scott

Coates

Davies

2012

Journal of the Intensive Care Society

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Clearing the spine of the unconscious traumatised patient is a task that the intensive care clinician faces frequently. Technological advances in cross-sectional imaging are such that the cervical and thoraco-lumbar spine can now be cleared quickly and reliably in a single computerised tomography imaging session, which all trauma patients require, with no extra exposure to radiation. This results in less patient manipulation and should reduce the time to cessation of unnecessary spinal precautions which themselves can lead to patient harm. Such head-to-toe inclusive ‘traumagrams’ are the standard of care received by casualties presenting at western military medical facilities in Afghanistan.

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The Evidence for Spinal Immobilization: An Estimate of the Magnitude of the Treatment Benefit

Cited by 11 publications

References 13 publications

Change from semi‐rigid to soft collars for prehospital management of trauma patients: An observational study

Change from semi‐rigid to soft collars for prehospital management of trauma patients: An observational study

Cervical Spine Motion Restriction After Blunt Trauma

Clearing the Spine in the Unconscious Trauma Patient: An Update

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