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Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2019

Open Access 01-12-2019 | Guideline

New clinical guidelines on the spinal stabilisation of adult trauma patients – consensus and evidence based

Authors: Christian Maschmann, Elisabeth Jeppesen, Monika Afzali Rubin, Charlotte Barfod

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2019

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Abstract

Traumatic spinal cord injury is a relatively rare injury in Denmark but may result in serious neurological consequences. For decades, prehospital spinal stabilisation with a rigid cervical collar and a hard backboard has been considered to be the most appropriate procedure to prevent secondary spinal cord injuries during patient transportation. However, the procedure has been questioned in recent years, due to the lack of high-quality studies supporting its efficacy. A national interdisciplinary task force was therefore established to provide updated clinical guidelines on prehospital procedures for spinal stabilisation of adult trauma patients in Denmark. The guidelines are based on a systematic review of the literature and grading of the evidence, in addition to a standardised consensus process.
This process yielded five main recommendations:
A strong recommendation against spinal stabilisation of patients with isolated penetrating trauma; a weak recommendation against the prehospital use of a rigid cervical collar and a hard backboard for ABCDE-stable patients; and a weak recommendation for the use of a vacuum mattress for patient transportation. Finally, our group recommends the use of our clinical algorithm to ensure good clinical practice.
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Literature
1.
go back to reference Bjørnshave Noe B, Mikkelsen E, Hansen R, Thygesen M, Hagen E. Incidence of traumatic spinal cord injury in Denmark, 1990–2012: a hospital-based study. Spinal Cord. 2015;53:436–40.CrossRef Bjørnshave Noe B, Mikkelsen E, Hansen R, Thygesen M, Hagen E. Incidence of traumatic spinal cord injury in Denmark, 1990–2012: a hospital-based study. Spinal Cord. 2015;53:436–40.CrossRef
2.
go back to reference National Association of Emergency Medical Technicians (U.S.). Pre-Hospital Trauma Life Support Committee., American College of Surgeons. Committee on Trauma. Spinal Trauma. In: Emerton C, editor. PHTLS® Prehospital Trauma Life Support. 8th ed. Burlington, MA: Jones & Bartlett Learning; 2016. p. 289–314. National Association of Emergency Medical Technicians (U.S.). Pre-Hospital Trauma Life Support Committee., American College of Surgeons. Committee on Trauma. Spinal Trauma. In: Emerton C, editor. PHTLS® Prehospital Trauma Life Support. 8th ed. Burlington, MA: Jones & Bartlett Learning; 2016. p. 289–314.
3.
go back to reference Subcommittee ATLS. American College of Surgeons’ committee on trauma, international ATLS working group. Spine and spinal cord trauma. In: Merrick C, editor. Adv trauma life support tenth Ed. 10th ed. American College of Surgeons: Chicago, Ill; 2018. p. 128–47. Subcommittee ATLS. American College of Surgeons’ committee on trauma, international ATLS working group. Spine and spinal cord trauma. In: Merrick C, editor. Adv trauma life support tenth Ed. 10th ed. American College of Surgeons: Chicago, Ill; 2018. p. 128–47.
4.
go back to reference Hood N, Considine J. Spinal immobilisaton in pre-hospital and emergency care: a systematic review of the literature. Australas Emerg Nurs J. 2015;18:118–37.CrossRef Hood N, Considine J. Spinal immobilisaton in pre-hospital and emergency care: a systematic review of the literature. Australas Emerg Nurs J. 2015;18:118–37.CrossRef
9.
go back to reference Brooke Lerner E, Billittier A, Moscati RR. The effects of neutral positioning with and without padding on spinal immobilization of healthy subjects. Prehospital Emerg Care. 1998;2:112–6.CrossRef Brooke Lerner E, Billittier A, Moscati RR. The effects of neutral positioning with and without padding on spinal immobilization of healthy subjects. Prehospital Emerg Care. 1998;2:112–6.CrossRef
11.
go back to reference Freauf M, Puckeridge N. To board or not to board: an evidence review of prehospital spinal immobilization. J Emerg Med. 2015;40:43–5. Freauf M, Puckeridge N. To board or not to board: an evidence review of prehospital spinal immobilization. J Emerg Med. 2015;40:43–5.
12.
go back to reference Taub EC. Cervical spine immobilization in athletes-to immobilize or not? A systematic review. Clin J Sport Med. 2017;27:E44–5. Taub EC. Cervical spine immobilization in athletes-to immobilize or not? A systematic review. Clin J Sport Med. 2017;27:E44–5.
13.
go back to reference Ham WHW, Schoonhoven L, Schuurmans MJ, Leenen LPH. Pressure ulcers, indentation marks and pain from cervical spine immobilization with extrication collars and headblocks: An observational study. J Care Inj [Internet]. 2016 [cited 2019 Apr 13];47:1924–31. Available from: https://doi.org/10.1016/j.injury.2016.03.032 Ham WHW, Schoonhoven L, Schuurmans MJ, Leenen LPH. Pressure ulcers, indentation marks and pain from cervical spine immobilization with extrication collars and headblocks: An observational study. J Care Inj [Internet]. 2016 [cited 2019 Apr 13];47:1924–31. Available from: https://​doi.​org/​10.​1016/​j.​injury.​2016.​03.​032
15.
go back to reference Hemmes B, Jeukens CRLPN, Al-Haidari A, Hofman PAM, Vd Linden ES, Brink PRG, et al. Effect of spineboard and headblocks on the image quality of head CT scans. Emerg Radiol. 2016;23:263–8.CrossRef Hemmes B, Jeukens CRLPN, Al-Haidari A, Hofman PAM, Vd Linden ES, Brink PRG, et al. Effect of spineboard and headblocks on the image quality of head CT scans. Emerg Radiol. 2016;23:263–8.CrossRef
17.
go back to reference Stokkeland JP, Andersen E, Bjørndal MM, Mikalsen AM, Aslaksen S, Hyldmo PK. Maintaining immobilisation devices on trauma patients during CT: a feasibility study. Scand J Trauma Resusc Emerg Med. 2017;25:1–8.CrossRef Stokkeland JP, Andersen E, Bjørndal MM, Mikalsen AM, Aslaksen S, Hyldmo PK. Maintaining immobilisation devices on trauma patients during CT: a feasibility study. Scand J Trauma Resusc Emerg Med. 2017;25:1–8.CrossRef
18.
go back to reference Nemunaitis G, Joan Roach M, Samir Hefzy M, Mejia M. Redesign of a spine board: proof of concept evaluation. AssistiveTechnology. 2016;28:144–51. Nemunaitis G, Joan Roach M, Samir Hefzy M, Mejia M. Redesign of a spine board: proof of concept evaluation. AssistiveTechnology. 2016;28:144–51.
19.
go back to reference Rao PJ, Phan K, Mobbs RJ, Wilson D, Ball J, Wales S, et al. Cervical spine immobilization in the elderly population. J Spine Surg. 2016;2:41–6.CrossRef Rao PJ, Phan K, Mobbs RJ, Wilson D, Ball J, Wales S, et al. Cervical spine immobilization in the elderly population. J Spine Surg. 2016;2:41–6.CrossRef
24.
go back to reference Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ CMAJ. 2010;182:E839–42.CrossRef Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ CMAJ. 2010;182:E839–42.CrossRef
25.
26.
go back to reference Danish Board of Health. Metodehåndbog for udarbejdelse af Nationale Kliniske Retningslinjer for puljeprojekter 2017–2020 (Handbook for the development of National Clinical Guidelines funded by the Danish Finance Act 2017–2020) [Internet]. 2017 [cited 2019 Mar 4]. Available from: https://www.sst.dk/da/nkr Danish Board of Health. Metodehåndbog for udarbejdelse af Nationale Kliniske Retningslinjer for puljeprojekter 2017–2020 (Handbook for the development of National Clinical Guidelines funded by the Danish Finance Act 2017–2020) [Internet]. 2017 [cited 2019 Mar 4]. Available from: https://​www.​sst.​dk/​da/​nkr
30.
go back to reference Rubin MA. Copenhagen Critical Care Symposium - FOAMmedic talk: The new National Clinical Guidelines on spinal stabilisation of adult trauma patients [Internet]. 2019 [cited 2019 Jun 23]. Available from: https://youtu.be/WnrmbQCqPTg Rubin MA. Copenhagen Critical Care Symposium - FOAMmedic talk: The new National Clinical Guidelines on spinal stabilisation of adult trauma patients [Internet]. 2019 [cited 2019 Jun 23]. Available from: https://​youtu.​be/​WnrmbQCqPTg
32.
go back to reference Holla M, Hannink G, Eggen TGE, Daanen RA, Allard Ã, Hosman JF, et al. Restriction of Cervical Intervertebral Movement With Different Types of External Immobilizers A Cadaveric 3D Analysis Study. Spine (Phila Pa 1976). 2017;42:E1182–9. Holla M, Hannink G, Eggen TGE, Daanen RA, Allard Ã, Hosman JF, et al. Restriction of Cervical Intervertebral Movement With Different Types of External Immobilizers A Cadaveric 3D Analysis Study. Spine (Phila Pa 1976). 2017;42:E1182–9.
33.
go back to reference Kwan I, Bunn F. Effects of prehospital spinal immobilization: a systematic review of randomized trials on healthy subjects. Prehosp Disaster Med. 2005;20:47–53.CrossRef Kwan I, Bunn F. Effects of prehospital spinal immobilization: a systematic review of randomized trials on healthy subjects. Prehosp Disaster Med. 2005;20:47–53.CrossRef
37.
go back to reference Barati K, Arazpour M, Vameghi R, Abdoli A, Farmani F. The effect of soft and rigid cervical collars on head and neck immobilization in healthy subjects. Asian Spine J. 2017;11:390–5.CrossRef Barati K, Arazpour M, Vameghi R, Abdoli A, Farmani F. The effect of soft and rigid cervical collars on head and neck immobilization in healthy subjects. Asian Spine J. 2017;11:390–5.CrossRef
39.
go back to reference Podolsky S, Baraff LJ, Simon RR, Hoffman JR, Larmon B, Ablon W. Efficacy of cervical spine immobilization methods. J Trauma. 1983;23:461–5.CrossRef Podolsky S, Baraff LJ, Simon RR, Hoffman JR, Larmon B, Ablon W. Efficacy of cervical spine immobilization methods. J Trauma. 1983;23:461–5.CrossRef
40.
go back to reference McCabe JB, Nolan DJ. Comparison of the effectiveness of different cervical immobilization collars. Ann Emerg Med. 1986;15:50–3.CrossRef McCabe JB, Nolan DJ. Comparison of the effectiveness of different cervical immobilization collars. Ann Emerg Med. 1986;15:50–3.CrossRef
41.
42.
go back to reference Theodore N, Hadley MN, Aarabi B, Dhall SS, Gelb DE. Hurlbert R John, et al. prehospital cervical spinal immobilization after trauma. Neurosurgery. 2013;3:22–34.CrossRef Theodore N, Hadley MN, Aarabi B, Dhall SS, Gelb DE. Hurlbert R John, et al. prehospital cervical spinal immobilization after trauma. Neurosurgery. 2013;3:22–34.CrossRef
43.
go back to reference Patel MB, Humble SS, Cullinane DC, Day MA, Jawa RS, Devin CJ, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the eastern Association for the Surgery of trauma. J Trauma Acute Care Surg. 2015;78:430–41.CrossRef Patel MB, Humble SS, Cullinane DC, Day MA, Jawa RS, Devin CJ, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the eastern Association for the Surgery of trauma. J Trauma Acute Care Surg. 2015;78:430–41.CrossRef
44.
go back to reference Ala A. Shams-Vahdati · S, Taghizadieh · a, Miri · S H, Kazemi · N, Hodjati · S R, et al. cervical collar effect on pulmonary volumes in patients with trauma. Eur J Trauma Emerg Surg. 2016;42:657–60.CrossRef Ala A. Shams-Vahdati · S, Taghizadieh · a, Miri · S H, Kazemi · N, Hodjati · S R, et al. cervical collar effect on pulmonary volumes in patients with trauma. Eur J Trauma Emerg Surg. 2016;42:657–60.CrossRef
45.
go back to reference Ham W, Schoonhoven L, Marieke M(, Schuurmans ) J, Luke L(, Leenen PH. Pressure ulcer development in trauma patients with suspected spinal injury; the influence of risk factors present in the Emergency Department. Int Emerg Nurs [Internet]. 2017 [cited 2019 Apr 13];30:13–9. Available from: https://doi.org/10.1016/j.ienj.2016.05.005 Ham W, Schoonhoven L, Marieke M(, Schuurmans ) J, Luke L(, Leenen PH. Pressure ulcer development in trauma patients with suspected spinal injury; the influence of risk factors present in the Emergency Department. Int Emerg Nurs [Internet]. 2017 [cited 2019 Apr 13];30:13–9. Available from: https://​doi.​org/​10.​1016/​j.​ienj.​2016.​05.​005
46.
go back to reference Maissan IM, Ketelaars R, Vlottes B, Hoeks SE, Den Hartog D, Stolker RJ. Increase in intracranial pressure by application of a rigid cervical collar: a pilot study in healthy volunteers. Eur J Emerg Med 2017;00:0–000. Maissan IM, Ketelaars R, Vlottes B, Hoeks SE, Den Hartog D, Stolker RJ. Increase in intracranial pressure by application of a rigid cervical collar: a pilot study in healthy volunteers. Eur J Emerg Med 2017;00:0–000.
47.
go back to reference Holla M. Value of a rigid collar in addition to head blocks: a proof of principle study. Emerg Med J. 2012;29:104 LP – 107. Holla M. Value of a rigid collar in addition to head blocks: a proof of principle study. Emerg Med J. 2012;29:104 LP – 107.
48.
go back to reference Prasarn ML, Hyldmo PK, Zdziarski LA, Loewy E, Dubose D, Horodyski M, et al. Comparison of the Vacuum Mattress versus the Spine Board Alone for Immobilization of the Cervical Spine Injured Patient A Biomechanical Cadaveric Study. Spine (Phila Pa 1976). 2017;42:E1398–402. Prasarn ML, Hyldmo PK, Zdziarski LA, Loewy E, Dubose D, Horodyski M, et al. Comparison of the Vacuum Mattress versus the Spine Board Alone for Immobilization of the Cervical Spine Injured Patient A Biomechanical Cadaveric Study. Spine (Phila Pa 1976). 2017;42:E1398–402.
49.
50.
go back to reference Kreinest M, Scholz M, Trafford P. on-scene treatment of spinal injuries in motor sports. Eur J Trauma Emerg Surg. 2017;43:191–200.CrossRef Kreinest M, Scholz M, Trafford P. on-scene treatment of spinal injuries in motor sports. Eur J Trauma Emerg Surg. 2017;43:191–200.CrossRef
52.
go back to reference Holla M, Driessen M, Eggen TGE, Daanen RA, Hosman AJF, Verdonschot N, et al. A new Craniothoracic mattress for immobilization of the cervical spine in critical care patients. J Trauma Nurs. 2017;24:261–9.CrossRef Holla M, Driessen M, Eggen TGE, Daanen RA, Hosman AJF, Verdonschot N, et al. A new Craniothoracic mattress for immobilization of the cervical spine in critical care patients. J Trauma Nurs. 2017;24:261–9.CrossRef
53.
go back to reference Domeier RM, Evans RW, Swor RA, Rivera-Rivera EJ, Frederiksen SM. Prehospital clinical findings associated with spinal injury. Prehospital Emerg Care. 1997;1:11–5.CrossRef Domeier RM, Evans RW, Swor RA, Rivera-Rivera EJ, Frederiksen SM. Prehospital clinical findings associated with spinal injury. Prehospital Emerg Care. 1997;1:11–5.CrossRef
54.
go back to reference Domeier RM, Evans RW, Swor RA, Hancock JB, Fales W, Krohmer J, et al. The reliability of prehospital clinical evaluation for potential spinal injury is not affected by the mechanism of injury. Prehospital Emerg Care. 1999;3:332–7.CrossRef Domeier RM, Evans RW, Swor RA, Hancock JB, Fales W, Krohmer J, et al. The reliability of prehospital clinical evaluation for potential spinal injury is not affected by the mechanism of injury. Prehospital Emerg Care. 1999;3:332–7.CrossRef
57.
go back to reference Burton JH, Dunn MG, Harmon NR, Hermanson TA, Bradshaw JR. A statewide, prehospital emergency medical service selective patient spine immobilization protocol. J Trauma. The Journal of Trauma: Injury, Infection, and Critical Care; 2006;61:161–7. Burton JH, Dunn MG, Harmon NR, Hermanson TA, Bradshaw JR. A statewide, prehospital emergency medical service selective patient spine immobilization protocol. J Trauma. The Journal of Trauma: Injury, Infection, and Critical Care; 2006;61:161–7.
59.
go back to reference Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med. 2000;343:94–9.CrossRef Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med. 2000;343:94–9.CrossRef
61.
go back to reference Martin MJ, Bush LD, Inaba K, Byerly S, Schreiber M, Peck KA, et al. Cervical spine evaluation and clearance in the intoxicated patient: a prospective Western trauma association multi-institutional trial and survey accreditation statement. J Trauma Acute Care Surg. 2017;83:1032–40.CrossRef Martin MJ, Bush LD, Inaba K, Byerly S, Schreiber M, Peck KA, et al. Cervical spine evaluation and clearance in the intoxicated patient: a prospective Western trauma association multi-institutional trial and survey accreditation statement. J Trauma Acute Care Surg. 2017;83:1032–40.CrossRef
62.
go back to reference Konstantinidis A, Plurad D, Barmparas G, Inaba K, Lam L, Bukur M, et al. The Presence of Nonthoracic Distracting Injuries Does Not Affect the Initial Clinical Examination of the Cervical Spine in Evaluable Blunt Trauma Patients: A Prospective Observational Study. J Trauma Inj Infect Crit Care [Internet]. 2011 [cited 2019 Apr 14];71:528–32. Available from: https://insights.ovid.com/crossref?an=00005373-201109000-00002 Konstantinidis A, Plurad D, Barmparas G, Inaba K, Lam L, Bukur M, et al. The Presence of Nonthoracic Distracting Injuries Does Not Affect the Initial Clinical Examination of the Cervical Spine in Evaluable Blunt Trauma Patients: A Prospective Observational Study. J Trauma Inj Infect Crit Care [Internet]. 2011 [cited 2019 Apr 14];71:528–32. Available from: https://​insights.​ovid.​com/​crossref?​an=​00005373-201109000-00002
64.
go back to reference Cason B, Rostas J, Simmons J, Frotan MA, Brevard SB, Gonzalez RP. Thoracolumbar spine clearance: clinical examination for patients with distracting injuries. J Trauma Acute Care Surg. 2016;80:125–30.CrossRef Cason B, Rostas J, Simmons J, Frotan MA, Brevard SB, Gonzalez RP. Thoracolumbar spine clearance: clinical examination for patients with distracting injuries. J Trauma Acute Care Surg. 2016;80:125–30.CrossRef
65.
67.
go back to reference Conrad BP, Del Rossi G, Horodyski MB, Prasarn ML, Alemi Y, Rechtine GR. Eliminating log rolling as a spine trauma order. Surg Neurol Int. 2012;3:188–97.CrossRef Conrad BP, Del Rossi G, Horodyski MB, Prasarn ML, Alemi Y, Rechtine GR. Eliminating log rolling as a spine trauma order. Surg Neurol Int. 2012;3:188–97.CrossRef
68.
go back to reference Hyldmo PK, Vist GE, Feyling AC, Rognås L, Magnusson V, Sandberg M, et al. Is the supine position associated with loss of airway patency in unconscious trauma patients? A systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med. 2015. Hyldmo PK, Vist GE, Feyling AC, Rognås L, Magnusson V, Sandberg M, et al. Is the supine position associated with loss of airway patency in unconscious trauma patients? A systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med. 2015.
69.
go back to reference Hyldmo PK, Horodyski MB, Conrad BP, Dubose DN, Røislien J, Prasarn M, et al. Safety of the lateral trauma position in cervical spine injuries: a cadaver model study. Acta Anaesthesiol Scand. 2016;60:1003–11.CrossRef Hyldmo PK, Horodyski MB, Conrad BP, Dubose DN, Røislien J, Prasarn M, et al. Safety of the lateral trauma position in cervical spine injuries: a cadaver model study. Acta Anaesthesiol Scand. 2016;60:1003–11.CrossRef
71.
go back to reference Tveit MS, Singh E, Olaussen A, Liew S, Fitzgerald MC, Mitra B. What is the purpose of log roll examination in the unconscious adult trauma patient during trauma reception? Emerg Med J. 2016;33:632–5.CrossRef Tveit MS, Singh E, Olaussen A, Liew S, Fitzgerald MC, Mitra B. What is the purpose of log roll examination in the unconscious adult trauma patient during trauma reception? Emerg Med J. 2016;33:632–5.CrossRef
Metadata
Title
New clinical guidelines on the spinal stabilisation of adult trauma patients – consensus and evidence based
Authors
Christian Maschmann
Elisabeth Jeppesen
Monika Afzali Rubin
Charlotte Barfod
Publication date
01-12-2019
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-019-0655-x

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