1
|
Mota M, Cunha M, Santos E, Abrantes T, Melo F, Monteiro M, Santos MR. Prehospital interventions to reduce discomfort caused by immobilization in adult trauma victims: a scoping review protocol. JBI Evid Synth 2022; 20:2743-2750. [PMID: 36081390 DOI: 10.11124/jbies-22-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this review is to identify the level of discomfort caused by immobilization as reported by trauma victims, and to map all the interventions in the prehospital context where they have been implemented and evaluated in order to reduce discomfort in adult victims of trauma. INTRODUCTION Immobilization is a cause of discomfort for trauma victims, which has important implications for the deterioration of vital signs and quality of life. However, discomfort caused by immobilization remains an under-explored topic by the scientific community. INCLUSION CRITERIA This scoping review will consider studies of adult victims of trauma, aged 18 years or over, in prehospital emergency care. Studies that focus on interventions designed to reduce immobilization discomfort, implemented and evaluated by health professionals, of any form, duration, frequency, and dose will be considered. METHODS An initial search of PubMed and CINAHL will be undertaken, followed by a second search for published and unpublished studies without time restrictions, in major health care-related electronic databases. Studies in English, French, Spanish, and Portuguese will be included. Data extraction will be performed independently by 2 reviewers in a tabular format and will include details about the level of discomfort, interventions, populations, study methods, and outcomes of interest. A narrative synthesis will accompany the results and will describe how they relate to the review objectives. REVIEW REGISTRATION NUMBER OSF https://osf.io/4scg5/.
Collapse
Affiliation(s)
- Mauro Mota
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.,Health School of the Polytechnic Institute of Viseu, Viseu, Portugal.,Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal.,Local Health Unit of Guarda, Guarda, Portugal.,INEM - National Institute of Medical Emergency, Lisboa, Portugal
| | - Madalena Cunha
- Health School of the Polytechnic Institute of Viseu, Viseu, Portugal.,Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Eduardo Santos
- Health School of the Polytechnic Institute of Viseu, Viseu, Portugal.,Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal.,Portugal Centre for Evidence-Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, Coimbra, Portugal
| | - Tito Abrantes
- Hospital São Teotónio, Tondela Viseu Hospital Centre, Viseu, Portugal
| | - Filipe Melo
- INEM - National Institute of Medical Emergency, Lisboa, Portugal.,Algarve Biomedical Center, Faro, Portugal.,Algarve Hospital and Universitary Centre, Faro, Portugal
| | | | - Margarida Reis Santos
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.,Nursing School of Porto, Porto, Portugal.,Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| |
Collapse
|
2
|
Sun H, Wilson J, Roach MJ, Hefzy MS, Nemunaitis G. Demonstration of pressure reduction in a new proof of concept spine board. Assist Technol 2019; 33:341-349. [PMID: 31437094 DOI: 10.1080/10400435.2019.1658658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Pressure injuries are a significant problem following spinal cord injury (SCI). High interface pressures while lying on a spine board during emergency transport appear to play a major role in their formation. The aim of the present study was to assess the interface pressures and sensing area between the body and the standard spine board (SSB) and a proof of concept spine board prototype (P-5). Twenty-one able-bodied subjects were assessed on each board. Interface pressures and sensing area were recorded every minute over 15 min. The mean peak pressure was higher on the SSB at the head, scapulothoracic (S-T), sacroiliac (S-I), and heels (227.6 mmHg, 148.9 mmHg, 360.3 mmHg, and 179.3 mmHg) compared to P-5 (51.9 mmHg, 60.1 mmHg, 66.8 mmHg, and 60.2 mmHg). The peak pressure index (PPI) at the head, S-T and S-I was higher on the SSB (100.2 mmHg, 101.6 mmHg, and 270.6 mmHg) compared to P-5 (41.6 mmHg, 51.9 mmHg and 58.7 mmHg). An analysis using pairwise comparisons for repeated measures showed that interface pressures (p < .05) and PPI (p < .001) were reduced at all locations. Modifications of a spine board incorporated in P-5 can dramatically reduce interface pressures and reduce pressure injury formation.
Collapse
Affiliation(s)
- Helen Sun
- Case Western Reserve University School of Medicine , Cleveland , Ohio , USA
| | - James Wilson
- Case Western Reserve University School of Medicine , Cleveland , Ohio , USA.,Department of Physical Medicine and Rehabilitation, Veterans Affairs Northeast Ohio Healthcare System , Cleveland , OH , USA
| | - Mary Joan Roach
- Case Western Reserve University School of Medicine , Cleveland , Ohio , USA.,MetroHealth Rehabilitation Institute, Cleveland , Ohio , USA.,Center for Health Research and Policy , Cleveland , Ohio , USA
| | - Mohamed Samir Hefzy
- Department of Mechanical, Industrial and Manufacturing Engineering, University of Toledo , Toledo , Ohio , USA
| | - Greg Nemunaitis
- Case Western Reserve University School of Medicine , Cleveland , Ohio , USA.,Center for Health Research and Policy , Cleveland , Ohio , USA
| |
Collapse
|
3
|
Nemunaitis G, Roach MJ, Hefzy MS, Mejia M. Redesign of a spine board: Proof of concept evaluation. Assist Technol 2018; 28:144-51. [PMID: 26852872 DOI: 10.1080/10400435.2015.1131759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Sacral pressure ulcers are a significant problem in individuals following spinal cord injury (SCI) and are felt to be in part due to the high interface-pressures applied to the body while lying on a standard spine board (SSB) during emergency transport. The aim of the present study was to assess the interface pressures and sensing areas between the body and the SSB and two proof of concept spine board prototypes (P-1 and P-2). Ten able-bodied individuals were assessed on each board. Interface pressures and sensing area were recorded every minute over 15 minutes. The highest pressure was generated at the sacral-iliac region. The mean of the peak pressures on the SSB, P-1, and P-2 was 288.6, 202.8, and 102.8 mmHg, respectively. The mean of the sensing areas on the SSB, P-1, and P-2 was 78.2, 98.5, and 109.4 in(2), respectively. An analysis using pairwise comparisons test showed the interface pressures were significantly reduced (p = 0.003) and the sensing area was significantly increased (p < 0.001) on P-2 in the sacral-iliac location. This study's procedures can be used when determining critical factors to guide the redesign of an SSB that reduces interface pressure and increases sensing area.
Collapse
Affiliation(s)
- Greg Nemunaitis
- a Department of PM&R, MetroHealth Rehabilitation Institute of Ohio , Cleveland , Ohio , USA.,b Department of PM&R, MetroHealth Medical Center , Cleveland , Ohio , USA.,c Department of PM&R, School of Medicine , Case Western Reserve University , Cleveland , Ohio , USA
| | - Mary Joan Roach
- c Department of PM&R, School of Medicine , Case Western Reserve University , Cleveland , Ohio , USA.,d Department of Research , Center for Health Research and Policy at MetroHealth Medical Center , Cleveland , Ohio , USA.,f Department of Research , MetroHealth Medical Center , Cleveland , Ohio , USA
| | - Mohamed Samir Hefzy
- e Biomechanics and Assistive Technology Laboratory, Departments of Bioengineering and Mechanical Engineering , The University of Toledo , Toledo , Ohio , USA
| | - Melvin Mejia
- a Department of PM&R, MetroHealth Rehabilitation Institute of Ohio , Cleveland , Ohio , USA.,b Department of PM&R, MetroHealth Medical Center , Cleveland , Ohio , USA.,c Department of PM&R, School of Medicine , Case Western Reserve University , Cleveland , Ohio , USA
| |
Collapse
|
4
|
Hemmes B, de Wert LA, Brink PR, Oomens CW, Bader DL, Poeze M. Cytokine IL1α and lactate as markers for tissue damage in spineboard immobilisation. A prospective, randomised open-label crossover trial. J Mech Behav Biomed Mater 2017; 75:82-88. [DOI: 10.1016/j.jmbbm.2017.06.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 11/29/2022]
|
5
|
Nemunaitis G, Roach MJ, Boulet M, Nagy JA, Kaufman B, Mejia M, Hefzy MS. The Effect of a Liner on the Dispersion of Sacral Interface Pressures During Spinal Immobilization. Assist Technol 2015; 27:9-17. [PMID: 26132220 DOI: 10.1080/10400435.2014.940473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Sacral pressure ulcers are a significant problem following spinal cord injury and are felt to be in part due to the high interface-pressures generated while strapped to the spine board. The objective of this study was to determine sacral interface-pressure and sensing area in healthy volunteers on a spine board and the effects of a gel pressure dispersion liner. Thirty-seven volunteers were placed on a pressure-sensing mat between the subject and the spine board. Measurements were carried out with and without a gel liner. Pressures and sensing area were recorded every minute for 40 minutes. The highest pressure was generated at the sacral prominence of each subject. Mean interface-pressures were higher on the spine board alone than with the gel liner (p < .0001). Overall, mean sensing area was lower on the spine board than with the gel liner (p < .0001). Standard spinal immobilization causes high sacral interface-pressures. The addition of a gel liner on the spine board decreased overall mean sacral pressures and increased mean sensing area. Generation of sacral pressure ulcers may be related to the initial interface-pressures generated while the patient is strapped to the spine board. The addition of a gel liner may reduce the incidence of sacral pressure ulcers.
Collapse
Affiliation(s)
- Greg Nemunaitis
- a MetroHealth Rehabilitation Institute of Ohio , Cleveland , Ohio , USA
| | | | | | | | | | | | | |
Collapse
|
6
|
Adib-Hajbaghery M, Maghaminejad F, Rajabi M. Efficacy of prehospital spine and limb immobilization in multiple trauma patients. Trauma Mon 2014; 19:e16610. [PMID: 25337517 PMCID: PMC4199294 DOI: 10.5812/traumamon.16610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/13/2014] [Accepted: 04/05/2014] [Indexed: 11/16/2022] Open
Abstract
Background: Injuries are a major cause of mortality and disability worldwide and are estimated to become the third leading cause of death by 2020. Most traffic deaths occur during the prehospital phase; consequently, prehospital trauma care has received considerable attention during the past decade. However, there is no study on the prehospital immobilization of spine and limbs in patients with multiple trauma in Iran. Objectives: This study aimed to investigate the epidemiology of trauma and the quality of limb and spine immobilization in patients with multiple trauma transferred to Shahid Beheshti Medical Center via emergency medical services (EMS). Patients and Methods: This cross-sectional study was conducted in 2013. The study population consisted of all patients with multiple trauma who had been transferred by EMS to the Central Trauma Department of the Shahid Beheshti Medical Center, Kashan, Iran. The study used a checklist and we recruited a convenience sample of 400 patients with multiple trauma. Data were described by using frequency tables, central tendency measures, and variability indices. Moreover, we analyzed data using SPSS. Results: The study sample consisted of 301 (75.2%) males and 99 (24.8%) females. The most common mechanism of trauma was traffic injuries (87.25%). Motorcyclists constituted 52.25% of the road traffic injuries victims. Overall, the quality of immobilization was at an undesirable level in 95.8% of patients with spine and limbs injuries. A significant association was observed between the quality of spine and limbs immobilization and the EMS workers’ education level (P = 0.005). Conclusions: The quality of spine and limb immobilizations was undesirable in more than 90% of cases. Due to the importance of good spine and limb immobilization in patients with multiple trauma, prehospital EMS technicians should be retrained for proper immobilization in patients suspected of spine or limb injuries. Developing evidence-based protocols and strengthening the regulatory and supervisory system to improve quality of prehospital emergency care in patients with multiple trauma is recommended.
Collapse
Affiliation(s)
- Mohsen Adib-Hajbaghery
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Mohsen Adib-Hajbaghery, Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel.: +98-3615550021, Fax: +98-3615556633, E-mail:
| | - Farzaneh Maghaminejad
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mahdi Rajabi
- Department of Anesthesiology, Kashan University of Medical Sciences, Kashan, IR Iran
| |
Collapse
|
7
|
White CC, Domeier RM, Millin MG. EMS spinal precautions and the use of the long backboard - resource document to the position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma. PREHOSP EMERG CARE 2014; 18:306-14. [PMID: 24559236 DOI: 10.3109/10903127.2014.884197] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Field spinal immobilization using a backboard and cervical collar has been standard practice for patients with suspected spine injury since the 1960s. The backboard has been a component of field spinal immobilization despite lack of efficacy evidence. While the backboard is a useful spinal protection tool during extrication, use of backboards is not without risk, as they have been shown to cause respiratory compromise, pain, and pressure sores. Backboards also alter a patient's physical exam, resulting in unnecessary radiographs. Because backboards present known risks, and their value in protecting the spinal cord of an injured patient remains unsubstantiated, they should only be used judiciously. The following provides a discussion of the elements of the National Association of EMS Physicians (NAEMSP) and American College of Surgeons Committee on Trauma (ACS-COT) position statement on EMS spinal precautions and the use of the long backboard. This discussion includes items where there is supporting literature and items where additional science is needed.
Collapse
|
8
|
Oomens CWJ, Zenhorst W, Broek M, Hemmes B, Poeze M, Brink PRG, Bader DL. A numerical study to analyse the risk for pressure ulcer development on a spine board. Clin Biomech (Bristol, Avon) 2013; 28:736-42. [PMID: 23953331 DOI: 10.1016/j.clinbiomech.2013.07.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 06/28/2013] [Accepted: 07/02/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Spine boards are used to immobilise accident victims suspected of having spinal injury. Guidelines about the maximum time patients remain on the board are often exceeded and on occasions may lead to pressure ulcers. Etiological research has shown that two processes ultimately lead to pressure ulcers:"Ischemic damage" which takes several hours to initiate and "deformation damage" at high strains. The latter process is very quick and the first signs of cell damage are already evident within minutes. Thus in order to minimise the risk of pressure ulcer development during prolonged loading, a new soft-layered long spine board has been designed. METHODS A subject specific numerical approach has been adopted to evaluate the prototype spine board in comparison to a conventional spine board, with reference to the estimated strains in the soft tissues adjacent to the sacrum in the supine position. The model geometry is derived from magnetic resonance images of three human volunteers in an unloaded situation. The loaded images are used to "tune" the material parameters of skin, fat and muscle. The prediction of the deformed contours on the soft-layered board is used to validate the model. FINDINGS Comparison of the internal strains in muscle tissue near the spine showed that internal strains on the soft-layered board are reduced and maximum strains are considerably less than the threshold at which deformation damage is possible. By contrast, on the rigid spine board this threshold is exceeded in all cases. INTERPRETATION The prototype comfort board is able to reduce the risk for deformation damage and thus reduces the risk of developing pressure ulcers.
Collapse
Affiliation(s)
- C W J Oomens
- Biomedical Engineering Department, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
9
|
Leenen LPH, van Hornsveld J. Overtillen van traumapatiënten. Crit Care 2011. [DOI: 10.1007/s12426-011-0053-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
10
|
Berg G, Nyberg S, Harrison P, Baumchen J, Gurss E, Hennes E. Near-Infrared Spectroscopy Measurement of Sacral Tissue Oxygen Saturation in Healthy Volunteers Immobilized on Rigid Spine Boards. PREHOSP EMERG CARE 2010; 14:419-24. [DOI: 10.3109/10903127.2010.493988] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
11
|
Reduced Tissue-Interface Pressure and Increased Comfort on a Newly Developed Soft-Layered Long Spineboard. ACTA ACUST UNITED AC 2010; 68:593-8. [DOI: 10.1097/ta.0b013e3181a5f304] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
|
13
|
Hinds JD, Allen G, Morris CG. Trauma and motorcyclists: born to be wild, bound to be injured? Injury 2007; 38:1131-8. [PMID: 17880974 DOI: 10.1016/j.injury.2007.06.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Revised: 06/14/2007] [Accepted: 06/18/2007] [Indexed: 02/02/2023]
Abstract
BACKGROUND Regrettably motorcyclists frequently suffer related significant injuries. Doctors who manage trauma will encounter victims of motorcycle accidents and many aspects of care are unique to these patients due to the protective and performance enhancing equipment used by motorcyclists. This review examines the patterns of major injuries suffered by motorcyclists, the unique aspects of airway, circulatory and spine management, and suggests some interventions, which may allow primary injury prevention for the future. DATA SOURCE Literature searches of the PubMed, EMBASE and Cochrane library with hand searches and author's experience. INTERVENTIONS None. DATA SYNTHESIS AND CONCLUSIONS The airway and (cervical and thoracolumbar) spine cannot be managed effectively in the helmeted patient with a speed hump in place and intubation by direct laryngoscopy is almost impossible with a speed hump in place. Helmets should be removed and the speed hump cut from the leathers. Leathers act as fracture splints, particularly for pelvis and lower extremities. Removal or extensive cutting away of the lower portion of leathers should be considered as part of "circulation", and only take place in a medical facility and in anticipation of circulatory deterioration. Motorcyclists sustaining thoracic spinal damage more frequently than cervical and spinal fractures at multiple levels are common. Back protectors are used commonly and these may be left in situ for extrication on a spinal board, but they should be removed in-hospital to allow full assessment. Injury prevention will require coordinated research and development of a number of key pieces of equipment and design in particular helmets, speed humps and clothing/textiles. In managing the injured motorcyclist in the pre or in-hospital settings, health professionals require greater awareness of the implications of such devices, which at the present time appears largely restricted to motorcycling enthusiasts.
Collapse
Affiliation(s)
- John D Hinds
- Specialist Registrar Anaesthetics, Motorcycle Union of Ireland (MCUI) Medical Team, Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, County Antrim, Ireland
| | | | | |
Collapse
|