Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 1/2022

01-02-2022 | Spinal Injury | Original Article

Evidence for the use of spinal collars in stabilising spinal injuries in the pre-hospital setting in trauma patients: a systematic review

Authors: Katherine Hawkridge, Ikhlaaq Ahmed, Zubair Ahmed

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2022

Login to get access

Abstract

Purpose

Spinal collars were introduced in 1967 into the management of spinal trauma care as it was thought that this technique of immobilisation would prevent any further neurological or spinal damage in high-risk patients. The aim of this systematic review was to determine whether the use of spinal collars in the pre-hospital trauma patient was recommended by published literature.

Methods

A systematic search of the literature was conducted between 1990 and 2020, screening PubMed, Medline, Science Direct and Google Scholar. The consequent findings were then qualitatively synthesised with the aim of effectively evaluating the evidence to resolve the discrepancy between current practice and literature.

Results

Of the nine eligible studies, six deemed that spinal collars should not be used in pre-hospital trauma patients with the remaining three reporting uncertainty if spinal collars were best practice. Our results suggest that there is a discrepancy between current guidance and practice in that although the guidelines recommend the use of spinal collars in the pre-hospital setting the majority of the studies were against the use of spinal collars. Importantly, none of the studies reported any benefits of spinal collars.

Conclusion

Our study shows a disparity between current guidelines and the published literature and warrants further direct research to obtain a more comprehensive view of the use of spinal collars in a pre-hospital setting.
Literature
1.
Kang Y, Ding H, Zhou HX, Wei ZJ, Liu L, Pan DY, Feng SQ. Epidemiology of worldwide spinal cord injury: a literature review. J Neuroestoratol. 2018;6:1–9.
2.
Stuke LE, Pons PT, Guy JS, Chapleau WP, Butler FK, McSwain NE. Prehospital spine immobilization for penetrating trauma—review and recommendations from the prehospital trauma life support executive committee. J Trauma. 2011;71(3):763–9.PubMed
3.
Sundstrom T, Asbjornsen H, Habiba S, Sunde GA, Wester K. Prehospital use of cervical collars in trauma patients: a critical review. Neurotrauma. 2014;31(6):531–40.CrossRef
4.
Kreinest M, Gliwitzky B, Schuler S, Grutzner PA, Munzberg M. Development of a new emergency medicine immobolization protocol for trauma patients and test of applicability by German emergency care providers. Scan J Trauma Resusc Ermeg Med. 2016;24:71.CrossRef
5.
6.
Kornhall DK, Jorgensen JJ, Brommelan T, Hyldmo PK, Asbjornsen H, Dolven T, Hansen T, Jeppesen E. The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury. BMC Med. 2017;25:2.
7.
Sundstrom T, Asbjornsen H, Habiba S, Sunde GA, Wester K. Prehospital use of cervical collars in trauma patients: a critical review. J Neurotrauma. 2014;31:531–40.CrossRefPubMedPubMedCentral
8.
Kwan I, Bunn F, Roberts IG. Spinal immobilisation for trauma patients. Cochrane Database Syst Rev. 2001;2001(1):002803.
9.
Kwan I, Bunn FB. Effects of prehospital spinal immobilization: a systematic review of randomized trails on healthy subjects. Prehosp Disast Med. 2005;20(1):47–53.CrossRef
10.
11.
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M. Preferred reporting items for systematic review and meta-analysis protocols (PRIMSA-P). Syst Rev. 2015;4:1.CrossRefPubMedPubMedCentral
12.
13.
Barkana Y, Stein M, Maor AS, Abramovich Y, Friedman Z, Knoller N. Pre-hospital stabilization of the cervical spine for penetrating injuries of the neck—is it necessary? Injury. 2000;31(5):305–9.CrossRefPubMed
14.
Brown JB, Bankey PE, Sangosanya AT, Cheng JD, Stassen NA, Gestring ML. Prehospital spinal immobilization does not appear to be beneficial and may complicate care following gunshot injury to the torso. J Trauma. 2009;67(4):774–8.PubMed
15.
16.
Haut ER, Kalish BT, Efron DT, Haider AH, Stevens KA, Kieninger AN, Cornwell EE, Chang DC. Spine immobilization in penetrating trauma: More harm than good? J Trauma. 2010;68(1):115–20.PubMed
17.
Lemyze M, Palud A, Favory R, Mathieu D. Unintentional strangulation by a cervical collar after attempted suicide by hanging. Emerg Med J. 2011;28(6):532.CrossRefPubMed
18.
Lin HL, Lee WC, Chen CW, Lin TY, Yc C, Yeh YS, Lin YK, Kuo LC. Neck collar used in treatment of victims of urban motorcycle accidents: over- or underproduction. Am J Emerg Med. 2011;29:1028–33.CrossRefPubMed
19.
Oosterwold JT, Sagel DC, Van Grunsven PM, Holla M, de Man-van GJ, Berben S. The characteristics and pre-hospital management of blunt trauma patients with suspected spinal column injuries: a retrospective observational study. Eur J Trauma Emerg Surg. 2017;43(4):513–24.CrossRefPubMed
20.
21.
Underbrink L, Dalton AT, Leonard J, Bourg PW, Blackmmore A, Valverde H, Candlin T, Caputo LM, Duran C, Peckham S, Beckham J, Daruna B, Furie K, Hopgood D. New immobilization guidelines change EMS critical thinking in older adults with spine trauma. Prehosp Emerg Care. 2018;22(5):637–44.CrossRefPubMed
22.
Vanderlan WB, Tew BE, McSwain NE. Increased risk of death with cervical spine immobilisation in penetrating cervical trauma. Injury. 2009;40(8):880–3.CrossRefPubMed
23.
24.
Davies G, Deakin C, Wilson A. The effect of a rigid collar on intracranial pressure. Injury. 1996;27:647–9.CrossRefPubMed
25.
Hunt K, Hallworth S, Smith M. The effects of rigid collar placement on intracranial and cerebral perfusion pressures. Anaesthesia. 2001;56:511–3.CrossRefPubMed
26.
Cordell WH, Hollingsworth JC, Olinger ML, Stroman SJ, Nelson DR. Pain and tissue-interface pressures during spine-board immobilization. Ann Emerg Med. 1995;26:31–6.CrossRefPubMed
27.
Swartz EE, Tucker WS, Nowak M, Roberto J, Hollingworth A, Decoster LC, et al. Prehospital cervical spine motion: immobilization versus spine motion restriction. Prehosp Emerg Care. 2018;22:630–6.CrossRefPubMed
28.
Ham W, Schoonhoven L, Schuurmans MJ, Leenen LPH. Pressure ulcers from spinal immobilization in trauma patients: a systematic review. J Trauma Acute Care Surg. 2014;76:1131–41.CrossRefPubMed
29.
Pernik MN, Seidel HH, Blalock RE, Burgess AR, Horodyski M, Rechtine GR, et al. Comparison of tissue-interface pressure in healthy subjects lying on two trauma splinting devices: the vacuum mattress splint and long spine board. Injury. 2016;47:1801–5.CrossRefPubMed
30.
Goutcher CM, Lochhead V. Reduction in mouth opening with semi-rigid cervical collars. Br J Anaesth. 2005;95:344–8.CrossRefPubMed
31.
Totten VY, Sugarman DB. Respiratory effects of spinal immobilization. Prehosp Emerg Care. 1999;3:347–52.CrossRefPubMed
32.
Liao S, Schneider NRE, Hüttlin P, Grützner PA, Weilbacher F, Matschke S, et al. Motion and dural sac compression in the upper cervical spine during the application of a cervical collar in case of unstable craniocervical junction–a study in two new cadaveric trauma models. PLoS ONE. 2018;13:e0195215.CrossRefPubMedPubMedCentral
33.
Domeier RM, Evans RW, Swor RA, Rivera-Rivera EJ, Frederiksen SM. Prehospital clinical findings associated with spinal injury. Prehosp Emerg Care. 1997;1:11–5.CrossRefPubMed
34.
Theodore N, Hadley MN, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, et al. Prehospital cervical spinal immobilization after trauma. Neurosurgery. 2013;72(Suppl 2):22–34.CrossRefPubMed
35.
Uzun DD, Jung MK, Weerts J, Munzberg M, Grutzner PA, Haske D, Kreinest M. Remaining cervical spine movement under different immobilization techniques. Prehosp Disast Med. 2020;35:382–7.CrossRef
36.
Butler J, Bates D. Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. Cervical collars in patients requiring spinal immobilization. EMJ. 2001;18:275.CrossRefPubMedPubMedCentral
37.
Ala A, Shams-Vahdati S, Taghizadieh A, et al. Cervical collar effect on pulmonary volumes in patients with trauma. Eur J Trauma Emerg Surg. 2016;42:657–60.CrossRefPubMed
Metadata
Title
Evidence for the use of spinal collars in stabilising spinal injuries in the pre-hospital setting in trauma patients: a systematic review
Authors
Katherine Hawkridge
Ikhlaaq Ahmed
Zubair Ahmed
Publication date
01-02-2022
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 1/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-020-01576-x

Other articles of this Issue 1/2022

European Journal of Trauma and Emergency Surgery 1/2022 Go to the issue

Original Article

Association between mortality and frailty in emergency general surgery: a systematic review and meta-analysis

Original Article

Epidemiology and treatment of acute elbow dislocations: current concept based on primary surgical ligament repair of unstable simple elbow dislocations

Original Article

Mortality in relation to presence and type of oral antithrombotic agent among adult trauma patients: a single-center retrospective cohort study

Editorial

Focus on emergency general surgery

Original Article

Blast polytrauma with hemodynamic shock, hypothermia, hypoventilation and systemic inflammatory response: description of a new porcine model

Original Article

Nasogastric tube after small bowel obstruction surgery could be avoided: a retrospective cohort study