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Kraai TW, Groen SR, Nawijn F, Panneman MJM, Hogervorst M, Brinke JGT, Goslings JC. The effect of ATLS/PHTLS spinal motion restriction protocol on the incidence of spinal cord injury, a nationwide database study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08421-4. [PMID: 39122846 DOI: 10.1007/s00586-024-08421-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/01/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE To study trends in incidence and outcome of patients with traumatic spinal cord injury (TSCI) in the Netherlands before, during and after implementation of the Advanced Trauma Life Support (ATLS®) and Pre-Hospital Trauma Life Support (PHTLS®)- Spinal Motion Restriction(SMR) protocol. METHODS In an observational database we studied national hospital admission and emergency department databases to analyse incidence rates and outcome of traumatic spinal cord injury and spinal fractures in the emergency department and in admittances in The Netherlands between 1986 and 2021. RESULTS A significant increase of 39% in TSCI in admitted patients with spinal fractures over the past 35 years (p < 0.001). This increase was especially prevalent in cervical spinal fractures (132%), while thoracic and lumbosacral spinal fractures showed a decrease in accompanied TSCI (64% and 88% respectively). The overall increase in spinal fractures was not significant. The duration of hospital admission decreased for spinal fractures without TSCI and with TSCI (66% and 56% respectively). CONCLUSION Since implementation of the SMR-protocol was aiming to limit TSCI in patients who suffered a spinal fracture, the increase in TSCI is an unexpected finding. Exact explanation for this increase is unclear and the contribution of the SMR-protocol is not fully understood due to confounders in the used datasets. Either way, the scientific evidence supporting this costly time- and labor-intensive SMR-protocol remains debated, along with evidence contradicting it. Therefore it stresses the need for clear, evidencebased reasoning for spinal immobilization according to ATLS, as this is currently lacking.
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Affiliation(s)
- Tijmen W Kraai
- Department of Surgery, University Medical Center Groningen, Groningen, Netherlands.
| | - Sylvester R Groen
- Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, Netherlands.
| | - Femke Nawijn
- Department of Surgery, Rijnstate Ziekenhuis, Arnhem, Netherlands
| | | | - Mike Hogervorst
- Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
| | | | - J Carel Goslings
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
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Bruton L, Nichols M, Looi S, Evens T, Bendall JC, Davis KJ. Evaluating soft collars in pre-hospital cervical spine immobilisation: A cohort study on neurological outcomes, patient comfort and paramedic perspectives. Emerg Med Australas 2024. [PMID: 39049205 DOI: 10.1111/1742-6723.14464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE Cervical spinal immobilisation procedures often include rigid cervical collars which, despite associated complications, may provide less immobilisation than previously thought. The present study reports the incidence of worsening neurological outcomes following soft collar application, and additionally reports patient comfort, compliance with spinal immobilisation, and paramedic perspectives on usage. METHODS This was an observational cohort study conducted in selected metropolitan and regional areas of NSW Ambulance between 1 May 2022 and 31 March 2023. Soft collars were used exclusively in place of rigid collars. The SPEED (SPinal Emergency Evaluation of Deficits) tool was used to evaluate new or worsening neurological deficits following pre-hospital soft collar application. Secondary outcomes included patient-reported comfort of the device, and paramedic assessment of efficacy. RESULTS Overall, 2098 soft collars were applied, of which 74 patients (3.5%) were subsequently found to have a cervical spine injury. Eight patients had a spinal cord injury, of which two experienced a worsening neurological deficit after soft collar application. In both instances, comprehensive case reviews determined that this was unlikely to have been attributable to the soft collar. The majority of patients found the soft collar comfortable, and they were well-tolerated by patients who generally complied with immobility directions. Paramedics found the collar easy to apply, and felt it assisted in minimising patient movement. CONCLUSIONS Pre-hospital use of soft collars does not appear to increase the risk of significant injury. Patients found these devices relatively comfortable, and clinicians reported overall ease of use with good patient compliance with immobility directives.
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Affiliation(s)
- Liam Bruton
- NSW Ambulance, 10 Dawn Fraser Avenue, Sydney Olympic Park, New South Wales, Australia
| | - Martin Nichols
- NSW Ambulance, 10 Dawn Fraser Avenue, Sydney Olympic Park, New South Wales, Australia
| | - Stephanie Looi
- NSW Ambulance, 10 Dawn Fraser Avenue, Sydney Olympic Park, New South Wales, Australia
| | - Thomas Evens
- NSW Ambulance, 10 Dawn Fraser Avenue, Sydney Olympic Park, New South Wales, Australia
| | - Jason C Bendall
- NSW Ambulance, 10 Dawn Fraser Avenue, Sydney Olympic Park, New South Wales, Australia
- Department of Anaesthesia & Intensive Care, University of Newcastle, Newcastle, New South Wales, Australia
| | - Kimberley J Davis
- NSW Ambulance, 10 Dawn Fraser Avenue, Sydney Olympic Park, New South Wales, Australia
- Graduate School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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3
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Gräff P, Bolduan L, Macke C, Clausen JD, Sehmisch S, Winkelmann M. Where Do We Stand on Cervical Spine Immobilisation? A Questionnaire among Prehospital Staff. J Clin Med 2024; 13:2325. [PMID: 38673598 PMCID: PMC11050990 DOI: 10.3390/jcm13082325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/07/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Cervical collars (CC) are routinely used in prehospital trauma treatment. However, over the past years, their application was discussed more critically since they increase intravenous pressure due to reduced venous drainage and the possibility of secondary cervical spine injury. Guidelines have been adjusted accordingly. The question is how efficient has this been put into practice, and how good, as well as up to date, is the knowledge of prehospital emergency medicine personnel about indications on cervical spine immobilisation? Methods: A 15-item questionnaire regarding the self-evaluation and result checking of the right indications for the use of a cervical collar in the prehospital setting was sent to paramedics and emergency doctors in Germany. Two hundred and nineteen completed surveys were statistically analysed. Results: Mean age of the participants was 30.45 ± 8.8. 72% were male. Regarding subjective safety, the appropriate indication of CC participants reached 79.8 ± 19.5 on a metric scale from 0 (no safety) to 100 (full safety). Mean right answers were as follows: Ambulance man (RS) 0.78 ± 0.84, paramedic (RA) 0.9 ± 0.74, paramedic (NFS) 1.03 ± 0.83 and emergency doctor (ED) 1.75 ± 1.06 (p = 0.013, Kruskal-Wallis Test). Participants who estimated their knowledge < 85% had 0.83 ± 0.8 right answers, and > 85% had 1.14 ± 0.9 right answers. Conclusions: Rational spine immobilisation is still necessary in severely injured patients. This study highlights the importance of continuing education using ongoing training, lectures or online learning with a questionnaire as a monitor for success to ensure the transfer of evidence-based medicine into daily practice.
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Affiliation(s)
- Pascal Gräff
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (M.W.)
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Hawkins SC, Williams J, Bennett BL, Islas A, Quinn R. Wilderness Medical Society Clinical Practice Guidelines for Spinal Cord Protection: 2024 Update. Wilderness Environ Med 2024; 35:78S-93S. [PMID: 38379496 DOI: 10.1177/10806032241227232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
The Wilderness Medical Society reconvened an expert panel to update best practice guidelines for spinal cord protection during trauma management. This panel, with membership updated in 2023, was charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in wilderness environments. Recommendations are made regarding several parameters related to spinal cord protection. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks/burdens for each parameter according to American College of Chest Physicians methodology. Key recommendations include the concept that interventions should be goal-oriented (spinal cord/column protection in the context of overall patient and provider safety) rather than technique-oriented (immobilization). An evidence-based, goal-oriented approach excludes the immobilization of suspected spinal injuries via rigid collars or backboards.
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Affiliation(s)
- Seth C Hawkins
- Department of Emergency Medicine, Wake Forest University, Winston-Salem, NC
| | - Jason Williams
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM
| | - Brad L Bennett
- Military & Emergency Medicine Department, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Arthur Islas
- Department of Family and Community Medicine, University of Nevada, Reno School of Medicine, Reno, NV
| | - Robert Quinn
- Department of Orthopaedic Surgery, University of Texas Health Science Center, San Antonio, TX
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Kissmer N, Morris D. Knowledge, attitude, and practices regarding cervical collars in adult trauma patients amongst practitioners at three hospitals in KwaZulu-Natal, South Africa. Afr J Emerg Med 2023; 13:241-244. [PMID: 37753240 PMCID: PMC10518319 DOI: 10.1016/j.afjem.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/03/2023] [Accepted: 09/03/2023] [Indexed: 09/28/2023] Open
Abstract
Background The use of cervical collars in adult patients with possible injuries to the cervical spine has been an accepted standard of care for many years, despite the absence of evidence for the efficacy of these devices in preventing unwanted movement and harm. Changes to the terminology and recommendations of major trauma guidelines have been made but are limited by low quality evidence. In this context, little is known about what practitioners know, believe, and do, when managing the cervical spine of trauma patients. Methods In this quantitative, observational, descriptive, cross-sectional survey a specifically designed questionnaire was used to collect data on the knowledge, attitude, and practices of practitioners managing adult trauma patients regarding cervical collars at three hospitals in KwaZulu-Natal, South Africa. Results A total of 128 completed questionnaires were collected, captured, and analysed. Participants with the additional qualification of ATLS and DipPEC had a mean knowledge score of 8.1 (SD=1.70), compared to those with no additional qualification of 4.5 (SD=1.9) (p<0.001). Participants in the Emergency Department (ED) attained a mean knowledge score of 7.1 (SD=2.2) followed by Surgery (Mean=6, SD=2.0), Orthopaedics (Mean=5.5, SD=1.7) and ICU/Anaesthetics (Mean=4.4, SD=1.8), p<0.001. Head blocks only were most frequently used by 97.4 % of ED, 55.6 % of Surgery, 3.8 % Orthopaedic and 22.2 % ICU/Anaesthetics participants (p<0.001). Conclusion The knowledge of management principles of cervical spine injuries was influenced by the department in which practitioners worked, the frequency that they managed patients with suspected injuries and additional courses. Head blocks were the most frequently used spinal protection device in all three hospitals. Most participants would be open to a change in practice if new guidelines were recommended. Further research is needed to determine the optimal management of patients with suspected cervical spine injuries and the role of motion restriction devices in limiting movement of the injured spine.
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Affiliation(s)
- Nicole Kissmer
- Emergency Department, Harry Gwala Regional Hospital, Plessislaer, South Africa
- Division of Emergency Medicine, University of KwaZulu Natal, Durban, South Africa
| | - David Morris
- Emergency Department, Harry Gwala Regional Hospital, Plessislaer, South Africa
- Division of Emergency Medicine, University of KwaZulu Natal, Durban, South Africa
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Jao S, Wang Z, Mukhi A, Chaudhary N, Martin J, Yuan V, Laskowski R, Huang E, Vosswinkel J, Singer AJ, Jawa R. Radiographic cervical spine injury patterns in admitted blunt trauma patients with and without prehospital spinal motion restriction. Trauma Surg Acute Care Open 2023; 8:e001092. [PMID: 38020851 PMCID: PMC10668292 DOI: 10.1136/tsaco-2023-001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives Selective prehospital cervical spine motion restriction (C-SMR) following blunt trauma has increasingly been used by emergency medical service (EMS) providers. We determined rates of prehospital C-SMR and concomitant radiographic injury patterns. Methods A retrospective trauma registry and chart review was conducted for all adult blunt trauma patients who were transported by EMS and hospitalized with radiographic cervical spine injuries from 2011 to 2019 at a level 1 trauma center. Results Of 658 admitted blunt trauma patients with confirmed cervical spine injury by imaging, 117 (17.8%) did not receive prehospital C-SMR. Patients without prehospital C-SMR were significantly older (76 vs 54 years), more often had low fall as mechanism of injury (59.8% vs 15.9%) and had lower Injury Severity Score (10 vs 17). Patients without C-SMR (Non-SMR) experienced the full array of cervical spine injury types and locations. While the non-SMR patients most often had dens fractures,C-SMR patients most often had C7 fractures; frequencies of fractures at the remaining vertebral levels were comparable. On MRI, cervical spinal cord (8.5% vs 19.6%) and ligamentous injuries (5.1% vs 12.6%) occurred less often in non-SMR patients. Approximately 8.5% of non-SMR patients and 20% of C-SMR patients required cervical spine surgery. Conclusion Patients without prehospital C-SMR demonstrate a broad array of cervical spine injuries. While the rates of certain cervical injuries are lower in prehospital non-SMR patients, they are not insignificant. Level of evidence Level III.
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Affiliation(s)
- Susan Jao
- Stony Brook University, Stony Brook, New York, USA
| | - Zhe Wang
- Stony Brook University, Stony Brook, New York, USA
| | - Ambika Mukhi
- Stony Brook University, Stony Brook, New York, USA
| | | | | | | | | | - Emily Huang
- Stony Brook University, Stony Brook, New York, USA
| | | | - Adam J Singer
- Emergency Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Randeep Jawa
- Stony Brook University, Stony Brook, New York, USA
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Courson R, Boden BP, Ellis J, Henry G, Rehberg R. Acute and Emergent Spinal Injury Assessment and Treatment. Clin Sports Med 2023; 42:491-514. [PMID: 37208061 DOI: 10.1016/j.csm.2023.02.011] [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: 05/21/2023]
Abstract
Sports participation is a leading cause of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. Planning the process of transport for home venues before the start of the season and ensuring that a medical time out occurs at home and away games can reduce complications of transport decisions on the field of play and expedite transport of the spine-injured athlete.
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Affiliation(s)
- Ron Courson
- Sports Medicine, University of Georgia, 1 Selig Circle, Butts-Mehre Hall, Athens, GA 30603, USA.
| | - Barry P Boden
- The Orthopaedic Center, a Division of Centers for Advanced Orthopaedics, 14995 Shady Grove Road, Suite 350, Rockville, MD 20815, USA
| | - Jim Ellis
- United States Football League, Birmingham, AL, USA; National Football League, 345 Park Avenue, New York, NY 10154, USA
| | - Glenn Henry
- Sports Medicine, University of Georgia, 1 Selig Circle, Butts-Mehre Hall, Athens, GA 30603, USA
| | - Robb Rehberg
- National Football League, 345 Park Avenue, New York, NY 10154, USA; William Paterson University, 300 Pompton Road, Wayne, NJ 07470, USA
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8
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Spears SDJ, Abdulle YF, Korovilas D, Torii R, Kalaskar DM, Sharma N. Neck Collar Assessment for People Living With Motor Neuron Disease: Are Current Outcome Measures Suitable? Interact J Med Res 2023; 12:e43274. [PMID: 36917160 PMCID: PMC10131796 DOI: 10.2196/43274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 03/15/2023] Open
Abstract
A majority of people living with motor neuron disease (MND) experience weakness of the neck and as a result, experience head drop. This exacerbates problems with everyday activities (eating, talking, breathing, etc). Neck collars are often used to support head drop; however, these are typically designed for prehospitalization settings to manage and brace the cervical region of the spine. As a result, it has been recorded that people living with MND often reject these collars for a variety of reasons but most notably because they are too restricting. The current standardized outcome measures (most notably restricting cervical range of motion) used for neck collars are summarized herein along with whether they are suitable for a bespoke neck collar specifically designed for people living with MND.
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Affiliation(s)
- Samuel D J Spears
- Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Sciences, University College London, London, United Kingdom.,National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Yusuf F Abdulle
- National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Department for Clinical and Movement Neurosciences, University College London, London, United Kingdom
| | | | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Deepak M Kalaskar
- Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Sciences, University College London, London, United Kingdom
| | - Nikhil Sharma
- National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Department for Clinical and Movement Neurosciences, University College London, London, United Kingdom
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McCurdy H. Critical Care Flight Nurses' role within secondary aeromedical services and the inter-hospital transfer of patients with acute spinal cord impairment. Contemp Nurse 2023:1-10. [PMID: 36632717 DOI: 10.1080/10376178.2023.2167728] [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: 01/13/2023]
Abstract
Aim: To highlight the role of secondary aeromedical services and required knowledge of Critical Care Flight Nurses (CCFN), in facilitating the safe inter-hospital transfer of patients with acute Spinal Cord Impairment (SCI) from a Major Trauma Centre (MTC) to a specialist SCI centre. Method: Literature search. Results: There is significant demand for secondary aeromedical services in order for patients with acute SCI to be transferred to a SCI centre within 24 h of injury. CCFN play an important role in triaging patients, coordinating patient care, arranging logistics of transport as well as providing direct clinical care inflight. CCFN must have knowledge regarding the pathophysiology of acute SCI, altitude physiology and interventions to manage stressors of flight in the aeromedical environment. Specific clinical challenges encountered by CCFN include the prevention of hypobaric hypoxic hypoxia and achieving appropriate immobilisation of the spine. Conclusion: Mitigating the increased risk associated with transporting critically unwell patients with SCI in the aeromedical environment, relies on aeromedical clinicians with education and training within the clinical specialty of aeromedical retrieval. The availability of secondary aeromedical services to undertake urgent inter-hospital retrieval of patients with acute SCI will be promoted by the continued development of Retrieval Nurse Practitioner (RNP) roles.
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Affiliation(s)
- Heather McCurdy
- Occupational and Aviation Medicine Unit, University of Otago, Wellington, New Zealand.,Canterbury Air Retrieval Service, Te Whatu Ora: Christchurch Intensive Care, New Zealand
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10
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Cowley A, Nelson M, Hall C, Goodwin S, Kumar DS, Moore F. Recommendation for changes to the guidelines of trauma patients with potential spinal injury within a regional UK ambulance trust. Br Paramed J 2022; 7:59-67. [PMID: 36531802 PMCID: PMC9730189 DOI: 10.29045/14784726.2022.12.7.3.59] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Spinal assessment and immobilisation has been a topic of debate for many years where, despite an emerging evidence base and the delivery of new guidance overseas, little has changed within UK pre-hospital practice. Since 2018, South East Coast Ambulance Service NHS Foundation Trust has spent time working with local trauma networks and expertise from within the region and international colleagues to develop a set of C-spine assessment and immobilisation guidelines that reflect the current best available international evidence and significant changes in international pre-hospital practice from settings such as Scandinavia and Australasia. METHODS A specialist group was commissioned to review the topic of pre-hospital spinal immobilisation and explore potential for evidence-based improvement. In conjunction with local trauma networks, subject matter experts and a thorough review of recent literature, a series of recommendations were made in order to improve spinal care within the authoring trust. RESULTS Seven recommendations were made, and an updated set of guidelines produced. These included the removal of semi-rigid collars from pre-hospital spinal immobilisation; the creation of two tiers of patients to ensure that the high-risk and low-risk populations are considered separately and an accompanying decision tool to safeguard both cohorts; an increased emphasis on the risk of spinal injury in the frail and older patient; an emphasis on spinal motion restriction rather than rigid immobilisation; an increased emphasis on self-extrication; and the use of a marker for emergency departments. SUMMARY An updated set of guidance has been produced using a combination of specialist and expert opinion alongside a literature review with close involvement of key stakeholders, both public and professional. The new guidance helps to ensure a patient-centred approach where each person is considered an individual with their risk of injury and management measures tailored to their specific needs.
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Affiliation(s)
- Alan Cowley
- South East Coast Ambulance Service NHS Foundation Trust ORCID iD: https://orcid.org/0000-0002-3093-4395
| | - Magnus Nelson
- South East Coast Ambulance Service NHS Foundation Trust
| | - Claire Hall
- South East Coast Ambulance Service NHS Foundation Trust
| | - Simon Goodwin
- South East Coast Ambulance Service NHS Foundation Trust
| | | | - Fionna Moore
- South East Coast Ambulance Service NHS Foundation Trust
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Häske D, Blumenstock G, Hossfeld B, Wölfl C, Schweigkofler U, Stock JP. The Immo Traffic Light System as a Decision-Making Tool for Prehospital Spinal Immobilization. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:753-758. [PMID: 35978468 PMCID: PMC9853232 DOI: 10.3238/arztebl.m2022.0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 01/24/2022] [Accepted: 07/21/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Spinal injuries are difficult injuries to assess yet can be associated with significant neurological damage. To avoid secondary damage, immobilization is considered state of the art trauma care. The indication for spinal immobilization must be assessed, however, for potential complications as well as its advantages and disadvantages. METHODS This systematic review addressing the question of the correct indication for spinal immobilization in trauma patients was compiled on the basis of our previously published analysis of possible predictors from the Trauma Registry of the German Society for Trauma Surgery. A Delphi procedure was then used to develop suggestions for action regarding immobilization based on the results of this review. RESULTS The search of the literature yielded 576 publications. The 24 publications included in the qualitative analysis report of 2 228 076 patients. A decision tool for spinal immobilization in prehospital trauma care was developed (Immo traffic light system) based on the results of the Delphi procedure. According to this system, severely injured patients with blunt trauma, severe traumatic brain injury, peripheral neurological symptoms, or spinal pain requiring treatment should be immobilized. Patients with a statistically increased risk of spinal injury as a result of the four cardinal features (fall >3m, severe trunk injury, supra clavicular injury, seniority [age >65 years]) should only have their spinal motion restricted after weighing up the pros and cons. Isolated penetrating trunk injuries should not be immobilized. CONCLUSION High-quality studies demonstrating the benefit of prehospital spinal immobilization are still lacking. Decision tools such as the Immo traffic light system can help weigh up the pros and cons of immobilization.
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Affiliation(s)
- David Häske
- Center for Public Health and Health Services Research, University Hospital of Tübingen, and German Red Cross Emergency Services Reutlingen,*Center for Public Health and Health Services Research University Hospital of Tübingen Osianderstr. 5 72076 Tübingen, Germany
| | - Gunnar Blumenstock
- Institute of Clinical Epidemiology and Applied Biometry, University Hospital of Tübingen
| | - Björn Hossfeld
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Federal Armed Forces Hospital of Ulm
| | - Christoph Wölfl
- Department for Orthopedic Surgery, Trauma and Sports Traumatology – Hand and Plastic Surgery, Musculoskeletal Center Neuwied, Marienhaus Hospital Neuwied
| | - Uwe Schweigkofler
- Department of Trauma and Orthopedic Surgery, BG Trauma Center, Frankfurt am Main
| | - Jan-Philipp Stock
- Department for Anesthesiology, Intensive Care Medicine, Emergency Medicine, Pain Therapy and Palliative Care, am Steinenberg Hospital, Reutlingen: Jan-Philipp Stock
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Ding Z, Ren Y, Cao H, Li Y, Chen S, Miao J, Li J. An Innovative Prone Position Using a Body-Shape Plaster Bed and Skull Traction for Posterior Cervical Spine Fracture Surgeries. Front Surg 2022; 9:649421. [PMID: 35356505 PMCID: PMC8960061 DOI: 10.3389/fsurg.2022.649421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background An innovative prone cervical spine surgical position using a body-shape plaster bed with skull traction (BSPST) was compared with the traditional prone surgical position with horseshoe headrests. Methods A total of 47 patients, undergoing posterior cervical spine surgery for cervical spine fracture, were retrospectively classified into two groups, the BSPST group (n = 24) and the traditional group (n = 23), and underwent a posterior instrumented fusion with or without decompression. Multiple indicators were used to evaluate the advantages of the BSPST compared with the traditional position. Results All the operations went smoothly. The mean recovery rate was 56.30% in the BSPST group and 48.55% in the traditional group (p = 0.454), with no significant difference. The intraoperative blood loss (177.5 ml vs. 439.1 ml, p = 0.003) and the total incidence of complications (8.3 vs. 47.8%, p = 0.004) were significantly less in the BSPST group than in the traditional group. In addition, the BSPST position provided a greater comfort level for the operators and allowed convenient intraoperative radiography. Conclusions This is the first study to describe a combined body-shape plaster bed and skull traction as an innovative cervical spine-prone surgical position that is simple, safe, and stable, intraoperative traction direction adjustable, reproducible, and economical for posterior cervical spine fracture surgery, and potentially other cervical and upper dorsal spine surgeries in the prone position. Additionally, this position provides the surgeons with a comfortable surgical field and can be easily achieved in most orthopedic operation rooms.
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Affiliation(s)
- Zhiyu Ding
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yijun Ren
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Hongqing Cao
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yuezhan Li
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Shijie Chen
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jinglei Miao
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jinsong Li
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Jinsong Li
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Nolte PC, Liao S, Kuch M, Grützner PA, Münzberg M, Kreinest M. Development of a New Emergency Medicine Spinal Immobilization Protocol for Pediatric Trauma Patients and First Applicability Test on Emergency Medicine Personnel. Pediatr Emerg Care 2022; 38:e75-e84. [PMID: 32604393 DOI: 10.1097/pec.0000000000002151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to (i) develop a protocol that supports decision making for prehospital spinal immobilization in pediatric trauma patients based on evidence from current scientific literature and (ii) perform an applicability test on emergency medicine personnel. METHODS A structured search of the literature published between 1980 and 2019 was performed in MEDLINE using PubMed. Based on this literature search, a new Emergency Medicine Spinal Immobilization Protocol for pediatric trauma patients (E.M.S. IMMO Protocol Pediatric) was developed. Parameters found in the literature, such as trauma mechanism and clinical findings that accounted for a high probability of spinal injury, were included in the protocol. An applicability test was administered to German emergency medicine personnel using a questionnaire with case examples to assess correct decision making according to the protocol. RESULTS The E.M.S. IMMO Protocol Pediatric was developed based on evidence from published literature. In the applicability test involving 44 emergency medicine providers revealed that 82.9% of participants chose the correct type of immobilization based on the protocol. A total of 97.8% evaluated the E.M.S. IMMO Protocol Pediatric as helpful. CONCLUSIONS Based on the current literature, the E.M.S. IMMO Protocol Pediatric was developed in accordance with established procedures used in trauma care. The decision regarding immobilization is made on based on the cardiopulmonary status of the patient, and life-threatening injuries are treated with priority. If the patient presents in stable condition, the necessity for full immobilization is assessed based upon the mechanisms of injury, assessment of impairment, and clinical examination.
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Affiliation(s)
- Philip C Nolte
- From the Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | | | - Matthias Kuch
- Pediatric Emergency Department, Karlsruhe City Clinic, Karlsruhe
| | - Paul A Grützner
- From the Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | | | - Michael Kreinest
- From the Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
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14
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The Impact of a Cervical Collar on Intracranial Pressure in Traumatic Brain Injury Patients: A Systematic Review and Meta-Analysis. TRAUMA CARE 2021. [DOI: 10.3390/traumacare2010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Although the use of a cervical collar in the prehospital setting is recommended to prevent secondary spinal cord injuries and ensure spinal immobilization, it is not known what effects this has on raising intracranial pressure (ICP) in traumatic brain injury (TBI) patients. In the absence of studies measuring ICP in the prehospital setting, the aim of this study was to systematically review the data related to ICP changes measured after presentation at the hospital in patients who had arrived wearing cervical collars. Methods: We searched Medline (PubMed), Embase, CINAHL, and Google Scholar for studies that investigated in-hospital ICP changes in TBI patients arriving at the hospital wearing collars. Titles, abstracts, and full texts were then searched for inclusion in the study. A narrative synthesis, as well as a meta-analysis, was performed. Results: Of the 1006 studies identified, only three met the inclusion/exclusion criteria. The quality of the three included studies was moderate and the risk of bias was low. All three studies used the Laerdal Stifneck collar, but all studies showed an increase in ICP after application of the collar. A further three studies that measured ICP but did not fit the systematic search were also included due to low patient numbers. A meta-analysis of the pooled data confirmed a significant increase in ICP, although between the four studies, only 77 patients were included. The meta-analysis also confirmed that after removal of the collar, there was a significant decrease in ICP. Conclusions: Our study suggests that the use of a cervical collar increases ICP in TBI and head injury patients, which may have detrimental effects. However, due to the extremely low sample size from all six studies, caution must be exercised when interpreting these data. Thus, further high-quality research is necessary to unequivocally clarify whether cervical collars should be used in patients with TBI.
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15
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Jung MK, von Ehrlich-Treuenstätt GVR, Keil H, Grützner PA, Schneider NRE, Kreinest M. Analysis of remaining motion using one innovative upper airway opening cervical collar and two traditional cervical collars. Sci Rep 2021; 11:20619. [PMID: 34663847 PMCID: PMC8523562 DOI: 10.1038/s41598-021-00194-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 09/24/2021] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to compare the remaining motion of an immobilized cervical spine using an innovative cervical collar as well as two traditional cervical collars. The study was performed on eight fresh human cadavers. The cervical spine was immobilized with one innovative (Lubo Airway Collar) and two traditional cervical collars (Stifneck and Perfit ACE). The flexion and lateral bending of the cervical spine were measured using a wireless motion tracker (Xsens). With the Weinman Lubo Airway Collar attached, the mean remaining flexion was 20.0 ± 9.0°. The mean remaining flexion was lowest with the Laerdal Stifneck (13.1 ± 6.6°) or Ambu Perfit ACE (10.8 ± 5.8°) applied. Compared to that of the innovative Weinmann Lubo Airway Collar, the remaining cervical spine flexion was significantly decreased with the Ambu Perfit ACE. There was no significant difference in lateral bending between the three examined collars. The most effective immobilization of the cervical spine was achieved when traditional cervical collars were implemented. However, all tested cervical collars showed remaining motion of the cervical spine. Thus, alternative immobilization techniques should be considered.
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Affiliation(s)
- Matthias K Jung
- BG Trauma Center Ludwigshafen, Clinic for Trauma and Orthopaedic Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen on the Rhine, Germany
| | - Gregor V R von Ehrlich-Treuenstätt
- BG Trauma Center Ludwigshafen, Clinic for Trauma and Orthopaedic Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen on the Rhine, Germany
| | - Holger Keil
- Clinic for Trauma and Orthopaedic Surgery, Universitätsklinikum Erlangen, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Paul A Grützner
- BG Trauma Center Ludwigshafen, Clinic for Trauma and Orthopaedic Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen on the Rhine, Germany
| | - Niko R E Schneider
- Clinic of Anesthesiology, University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Michael Kreinest
- BG Trauma Center Ludwigshafen, Clinic for Trauma and Orthopaedic Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen on the Rhine, Germany.
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16
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d'Arville A, Walker M, Lacey J, Lancman B, Hendel S. Airway management in the adult patient with an unstable cervical spine. Curr Opin Anaesthesiol 2021; 34:597-602. [PMID: 34325462 DOI: 10.1097/aco.0000000000001040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The ideal airway management of patients with unstable spinal injury presents a perennial challenge for anaesthesiologists. With competing interests, potentially catastrophic complications, and a scarcity of evidence to support common practices, it is an area rich with dogma and devoid of data. This review seeks to highlight recent evidence that improves our assurance that what we do to manage the airway in the unstable cervical spine is supported by data. RECENT FINDINGS The increasing range of available technology for intubation provides important opportunities to investigate the superiority (or otherwise) of various techniques - and a chance to challenge accepted practice. Long-held assumptions regarding spinal immobilisation in the context of airway management may require refinement as a true base of evidence develops. SUMMARY Video laryngoscopy may replace direct laryngoscopy as the default technique for endotracheal intubation in patients with suspected or confirmed spinal instability. Immobilisation of the unstable cervical spine, manually or with rigid cervical collars, is increasingly controversial. It may be that hard collars are used in specific circumstances, rather than as universal precaution in the future.There are no recent data of significantly high quality to warrant wholesale changes to recommended airway management practice and in the absence of new information, limiting movement (in the suspected or confirmed unstable cervical spine) remains the mainstay of clinical practice advice.
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Affiliation(s)
- Asha d'Arville
- Department of Anaesthesiology and Perioperative Medicine, Alfred Health, Melbourne, Australia
| | - Matthew Walker
- Department of Anaesthesiology and Perioperative Medicine, Alfred Health, Melbourne, Australia
- The Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Jonathan Lacey
- Department of Anaesthesiology and Perioperative Medicine, Alfred Health, Melbourne, Australia
| | - Benn Lancman
- Department of Anaesthesiology and Perioperative Medicine, Alfred Health, Melbourne, Australia
| | - Simon Hendel
- Department of Anaesthesiology and Perioperative Medicine, Alfred Health, Melbourne, Australia
- The Central Clinical School, Monash University
- The National Trauma Research Institute, Melbourne, Australia
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17
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Schleicher P, Scholz M, Castein J, Kandziora F. [Guideline-conform treatment of injuries to the subaxial cervical spine]. Unfallchirurg 2021; 124:931-944. [PMID: 34529103 DOI: 10.1007/s00113-021-01087-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
Injuries to the subaxial cervical spine are increasing and have an increased neurological risk compared to the thoracic and lumbar spines. The current treatment recommendations according to the therapeutic recommendations of the Spine Section of the German Society for Orthopedics and Trauma Surgery (DGOU) as well as the S1 guidelines of the German Trauma Society (DGU) are presented. This second part of the article describes the correct indications and treatment planning for injuries to the cervical spine. Based on the AOSpine classification for subaxial cervical spine injuries, decisions can be made about conservative or surgical treatment as well as individual details of the treatment. The underlying principles of treatment are relief of neurological structures, restoration of stability and reconstruction/preservation of the physiological alignment.
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Affiliation(s)
- Philipp Schleicher
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main gGmbH, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland.
| | - Matti Scholz
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main gGmbH, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland
| | - Jens Castein
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main gGmbH, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland
| | - Frank Kandziora
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main gGmbH, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland
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18
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Jung MK, Grützner PA, Schneider NRE, Keil H, Kreinest M. Cervical Spine Immobilization in Patients With a Geriatric Facial Structure: The Influence of a Geriatric Mandible Structure on the Immobilization Quality Using a Cervical Collar. Geriatr Orthop Surg Rehabil 2021; 12:21514593211021824. [PMID: 34178417 PMCID: PMC8202247 DOI: 10.1177/21514593211021824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/04/2021] [Accepted: 05/09/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Demographic changes have resulted in an increase in injuries among geriatric patients. For these patients, a rigid cervical collar is crucial for immobilizing the cervical spine. However, evidence suggests that patients with a geriatric facial structure require a different means of immobilization than patients with an adult facial structure. This study aimed to analyze the remaining motion of the immobilized cervical spine based on facial structure. MATERIALS AND METHODS This study was performed on 8 fresh human cadavers. Facial structure was evaluated via ascertaining the mandibular angle by computer tomography. A mandibular angle below 130°, belongs to the adult facial structure group (n = 4) and a mandibular angle above 130°, belongs to the geriatric facial structure group (n = 4). The flexion and lateral bending of the immobilized cervical spine were analyzed in both groups using a wireless motion tracker system. RESULTS A flexion of up to 19.0° was measured in the adult facial structure group. The mean flexion in the adult vs. geriatric facial structure groups were 14.5° vs. 6.5° (ranges: 9.0-19.0 vs. 5.0-7.0°), respectively. Thus, cervical spine motion was (p = 0.0286) significantly more reduced in the adult facial structure group. No (p = 0.0571) significant difference was oberserved in the mean lateral bending of the adult facial structure group (14.5°) compared to the geriatric facial structure group (7.5°). CONCLUSION Emergency medical service personnel should therefore follow current guidelines and recommendations and perform cervical spine immobilization with a cervical collar, including in patients with a geriatric facial structure.
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Affiliation(s)
- Matthias K. Jung
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - Paul A. Grützner
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | | | - Holger Keil
- Clinic for Trauma and Orthopaedic Surgery, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Michael Kreinest
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
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19
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Philipp LR, Leibold A, Mahtabfar A, Montenegro TS, Gonzalez GA, Harrop JS. Achieving Value in Spine Surgery: 10 Major Cost Contributors. Global Spine J 2021; 11:14S-22S. [PMID: 33890804 PMCID: PMC8076814 DOI: 10.1177/2192568220971288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Narrative Review. OBJECTIVES The increasing cost of healthcare overall and for spine surgery, coupled with the growing burden of spine-related disease and rising demand have necessitated a shift in practice standards with a new emphasis on value-based care. Despite multiple attempts to reconcile the discrepancy between national recommendations for appropriate use and the patterns of use employed in clinical practice, resources continue to be overused-often in the absence of any demonstrable clinical benefit. The following discussion illustrates 10 areas for further research and quality improvement. METHODS We present a narrative review of the literature regarding 10 features in spine surgery which are characterized by substantial disproportionate costs and minimal-if any-clear benefit. Discussion items were generated from a service-wide poll; topics mentioned with great frequency or emphasis were considered. Items are not listed in hierarchical order, nor is the list comprehensive. RESULTS We describe the cost and clinical data for the following 10 items: Over-referral, Over-imaging & Overdiagnosis; Advanced Imaging for Low Back Pain; Advanced imaging for C-Spine Clearance; Advanced Imaging for Other Spinal Trauma; Neuromonitoring for Cervical Spine; Neuromonitoring for Lumbar Spine/Single-Level Surgery; Bracing & Spinal Orthotics; Biologics; Robotic Assistance; Unnecessary perioperative testing. CONCLUSIONS In the pursuit of value in spine surgery we must define what quality is, and what costs we are willing to pay for each theoretical unit of quality. We illustrate 10 areas for future research and quality improvement initiatives, which are at present overpriced and underbeneficial.
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Affiliation(s)
- Lucas R. Philipp
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA,Lucas R. Philipp, Thomas Jefferson University, 909 Walnut St., 3 rd Floor, Department of Neurosurgery, Philadelphia, PA 19107, USA.
| | - Adam Leibold
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Aria Mahtabfar
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Thiago S. Montenegro
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Glenn A. Gonzalez
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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20
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Asha SE, Curtis K, Healy G, Neuhaus L, Tzannes A, Wright K. Neurologic outcomes following the introduction of a policy for using soft cervical collars in suspected traumatic cervical spine injury: A retrospective chart review. Emerg Med Australas 2020; 33:19-24. [DOI: 10.1111/1742-6723.13646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/25/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Stephen E Asha
- Emergency Department St George Hospital Sydney New South Wales Australia
- St George and Sutherland Clinical School, Faculty of Medicine The University of New South Wales Sydney New South Wales Australia
| | - Kate Curtis
- Sydney Nursing School The University of Sydney Sydney New South Wales Australia
- Emergency Services Illawarra Shoalhaven Local Health District Wollongong New South Wales Australia
- Illawarra Health and Medical Research Institute Wollongong New South Wales Australia
- The George Institute for Global Health Sydney New South Wales Australia
- Faculty of Science, Medicine and Health University of Wollongong Wollongong New South Wales Australia
| | - Georgina Healy
- Emergency Services Illawarra Shoalhaven Local Health District Wollongong New South Wales Australia
- Faculty of Science, Medicine and Health University of Wollongong Wollongong New South Wales Australia
| | - Lauren Neuhaus
- Emergency Department St George Hospital Sydney New South Wales Australia
| | - Alexander Tzannes
- Emergency Department St George Hospital Sydney New South Wales Australia
- St George and Sutherland Clinical School, Faculty of Medicine The University of New South Wales Sydney New South Wales Australia
- NSW Ambulance Aeromedical Operations Sydney New South Wales Australia
| | - Kelly Wright
- Emergency Department The Sutherland Hospital Sydney New South Wales Australia
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21
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Courson R, Ellis J, Herring SA, Boden BP, Henry G, Conway D, McNamara L, Neal TL, Putukian M, Sills AK, Walpert KP. Best Practices and Current Care Concepts in Prehospital Care of the Spine-Injured Athlete in American Tackle Football March 2-3, 2019; Atlanta, GA. J Athl Train 2020; 55:545-562. [PMID: 32579669 PMCID: PMC7319739 DOI: 10.4085/1062-6050-430-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Sport-related spine injury can be devastating and have long-lasting effects on athletes and their families. Providing evidence-based care for patients with spine injury is essential for optimizing postinjury outcomes. When caring for an injured athlete in American tackle football, clinicians must make decisions that involve unique challenges related to protective equipment (eg, helmet and shoulder pads). The Spine Injury in Sport Group (SISG) met in Atlanta, Georgia, March 2-3, 2019, and involved 25 health care professionals with expertise in emergency medicine, sports medicine, neurologic surgery, orthopaedic surgery, neurology, physiatry, athletic training, and research to review the current literature and discuss evidence-based medicine, best practices, and care options available for the prehospital treatment of athletes with suspected cervical spine injuries.1,2 That meeting and the subsequent Mills et al publication delineate the quality and quantity of published evidence regarding many aspects of prehospital care for the athlete with a suspected cervical spine injury. This paper offers a practical treatment guide based on the experience of those who attended the Atlanta meeting as well as the evidence presented in the Mills et al article. Ongoing research will help to further advance clinical treatment recommendations.
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Affiliation(s)
| | - James Ellis
- University of South Carolina School of Medicine, Greenville
| | - Stanley A Herring
- Department of Rehabilitation Medicine and The Sports Institute, University of Washington, Seattle
| | - Barry P Boden
- The Orthopaedic Center, A Division of CAO, Rockville, MD
| | | | | | - Lance McNamara
- Barrow County Schools, Winder-Barrow High School, Winder, GA
| | | | - Margot Putukian
- University Health Services, Rugers Robert Wood Johnson Medical School, Princeton, NJ
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22
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Beauséjour MH, Petit Y, Hagen J, Arnoux PJ, Thiong JMM, Wagnac E. Contribution of injured posterior ligamentous complex and intervertebral disc on post-traumatic instability at the cervical spine. Comput Methods Biomech Biomed Engin 2020; 23:832-843. [PMID: 32463324 DOI: 10.1080/10255842.2020.1767776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Posterior ligamentous complex (PLC) and intervertebral disc (IVD) injuries are common cervical spine flexion-distraction injuries, but the residual stability following their disruption is misknown. The objective of this study was to evaluate the effect of PLC and IVD disruption on post-traumatic cervical spine stability under low flexion moment (2 Nm) using a finite element (FE) model of C2-T1. The PLC was removed first and a progressive disc rupture (one third, two thirds and complete rupture) was modeled to simulate IVD disruption at C2-C3, C4-C5 and C6-C7. At each step, a non-traumatic flexion moment was applied and the change in stability was evaluated. PLC removal had little impact at C2-C3 but increased local range of motion (ROM) at the injured level by 77.2% and 190.7% at C4-C5 and C6-C7, respectively. Complete IVD rupture had the largest impact on C2-C3, increasing C2-C3 ROM by 181% and creating a large antero-posterior displacement of the C2-C3 segment. The FE analysis showed PLC and disc injuries create spinal instability. However, the PLC played a bigger role in the stability of the middle and lower cervical spine while the IVD was more important at the upper cervical spine. Stabilization appears important when managing patients with soft tissue injuries.
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Affiliation(s)
- Marie-Hélène Beauséjour
- Department of Mechanical Engineering, Ecole de technologie superieure, Montreal, Canada.,Department of traumatology and acute care, Research Center, Hopital du Sacre-Coeur de Montreal, Montreal, Canada.,Department TS2, Laboratoire de biomecanique appliquee, IFSTTAR, LBA UMR T24, Aix-Marseille Universite, Marseille, France
| | - Yvan Petit
- Department of Mechanical Engineering, Ecole de technologie superieure, Montreal, Canada.,Department of traumatology and acute care, Research Center, Hopital du Sacre-Coeur de Montreal, Montreal, Canada
| | - Jeremy Hagen
- Department of Mechanical Engineering, Ecole de technologie superieure, Montreal, Canada.,Department of traumatology and acute care, Research Center, Hopital du Sacre-Coeur de Montreal, Montreal, Canada
| | - Pierre-Jean Arnoux
- Department TS2, Laboratoire de biomecanique appliquee, IFSTTAR, LBA UMR T24, Aix-Marseille Universite, Marseille, France
| | - Jean-Marc Mac Thiong
- Department of traumatology and acute care, Research Center, Hopital du Sacre-Coeur de Montreal, Montreal, Canada
| | - Eric Wagnac
- Department of Mechanical Engineering, Ecole de technologie superieure, Montreal, Canada.,Department of traumatology and acute care, Research Center, Hopital du Sacre-Coeur de Montreal, Montreal, Canada
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Abstract
BACKGROUND Immobilization of the cervical spine by Emergency Medical Services (EMS) personnel is a standard procedure. In most EMS, multiple immobilization tools are available.The aim of this study is the analysis of residual spine motion under different types of cervical spine immobilization. METHODS In this explorative biomechanical study, different immobilization techniques were performed on three healthy subjects. The test subjects' heads were then passively moved to cause standardized spinal motion. The primary endpoints were the remaining range of motion for flexion, extension, bending, and rotation measured with a wireless human motion detector. RESULTS In the case of immobilization of the test person (TP) on a straight (0°) vacuum mattress, the remaining rotation of the cervical spine could be reduced from 7° to 3° by additional headblocks. Also, the remaining flexion and extension were reduced from 14° to 3° and from 15° to 6°, respectively. The subjects' immobilization was best on a spine board using a headlock system and the Spider Strap belt system (MIH-Medical; Georgsmarienhütte, Germany). However, the remaining cervical spine extension increased from 1° to 9° if a Speedclip belt system was used (Laerdal; Stavanger, Norway). The additional use of a cervical collar was not advantageous in reducing cervical spine movement with a spine board or vacuum mattress. CONCLUSIONS The remaining movement of the cervical spine is minimal when the patient is immobilized on a spine board with a headlock system and a Spider Strap harness system or on a vacuum mattress with additional headblocks. The remaining movement of the cervical spine could not be reduced by the additional use of a cervical collar.
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24
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Roquilly A, Vigué B, Boutonnet M, Bouzat P, Buffenoir K, Cesareo E, Chauvin A, Court C, Cook F, de Crouy AC, Denys P, Duranteau J, Fuentes S, Gauss T, Geeraerts T, Laplace C, Martinez V, Payen JF, Perrouin-Verbe B, Rodrigues A, Tazarourte K, Prunet B, Tropiano P, Vermeersch V, Velly L, Quintard H. French recommendations for the management of patients with spinal cord injury or at risk of spinal cord injury. Anaesth Crit Care Pain Med 2020; 39:279-289. [PMID: 32229270 DOI: 10.1016/j.accpm.2020.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To update the French guidelines on the management of trauma patients with spinal cord injury or suspected spinal cord injury. DESIGN A consensus committee of 27 experts was formed. A formal conflict-of-interest (COI) policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e. pharmaceutical, medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. METHODS The committee studied twelve questions: (1) What are the indications and arrangements for spinal immobilisation? (2) What are the arrangements for pre-hospital orotracheal intubation? (3) What are the objectives of haemodynamic resuscitation during the lesion assessment, and during the first few days in hospital? (4) What is the best way to manage these patients to improve their long-term prognosis? (5) What is the place of corticosteroid therapy in the initial phase? (6) What are the indications for magnetic resonance imaging in the lesion assessment phase? (7) What is the optimal time for surgical management? (8) What are the best arrangements for orotracheal intubation in the hospital environment? (9) What are the specific conditions for weaning these patients from mechanical ventilation for? (10) What are the procedures for analgesic treatment of these patients? (11) What are the specific arrangements for installing and mobilising these patients? (12) What is the place of early intermittent bladder sampling in these patients? Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® Methodology. RESULTS The experts' work synthesis and the application of the GRADE method resulted in 19 recommendations. Among the recommendations formalised, 2 have a high level of evidence (GRADE 1+/-) and 12 have a low level of evidence (GRADE 2+/-). For 5 recommendations, the GRADE method could not be applied, resulting in expert advice. After two rounds of scoring and one amendment, strong agreement was reached on all the recommendations. CONCLUSIONS There was significant agreement among experts on strong recommendations to improve practices for the management of patients with spinal cord injury.
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Affiliation(s)
- A Roquilly
- Anaesthesiology and Intensive Care Unit, Hôtel-Dieu, Nantes University Hospital, Nantes, France.
| | - B Vigué
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - M Boutonnet
- Hôpital d'instruction des armées Percy, Clamart, France
| | - P Bouzat
- Grenoble Alps Trauma Centre, Department of Anaesthesia and Critical Care, Grenoble University Hospital, Grenoble, France
| | - K Buffenoir
- Neurosurgery department, Nantes University Hospital, Nantes, France
| | - E Cesareo
- Edouard-Herriot University Hospital, Lyon, France
| | - A Chauvin
- Anaesthesiology and Intensive Care Unit, Lariboisière Hospital, AP-HP, Paris, France
| | - C Court
- Orthopaedic Surgery Department, Spine and Bone Tumor Unit, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - F Cook
- Unité de réanimation chirurgicale polyvalente et de polytraumatologie, Albert-Chenevier-Henri-Mondor University Hospital, Créteil, France
| | - A C de Crouy
- Unité SRPR/Réanimation chirurgicale, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - P Denys
- Orthopaedic department, Spine and Bone Tumor Unit. Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - J Duranteau
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - S Fuentes
- Aix-Marseille University, AP-HM, Department of Neurosurgery, University Hospital Timone, Marseille, France
| | - T Gauss
- Post-Intensive Care Rehabilitation Unit, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - T Geeraerts
- Anaesthesiology and Critical Care Department, Toulouse University Hospital, University of Toulouse 3-Paul Sabatier, Toulouse, France
| | - C Laplace
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - V Martinez
- Neuro Urology Unit, Department of Physical Medicine and Rehabilitation. Raymond Poincaré University Hospital, Garches, France
| | - J F Payen
- Department of Anaesthesia and Critical Care, Grenoble Alps University Hospital, 38000 Grenoble, France
| | - B Perrouin-Verbe
- Department of Neurological Physical Medicine and Rehabilitation, Nantes University Hospital, Nantes, France
| | - A Rodrigues
- Anaesthesiology and Intensive Care Unit, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - K Tazarourte
- Emergency department, Edouard-Herriot University Hospital, 69003 Lyon, France
| | - B Prunet
- Department of Anaesthesia and Critical Care, Val-de-Grâce Hospital, Paris, France
| | - P Tropiano
- Aix-Marseille University, AP-HM, Orthopaedic and traumatic surgery, University Hospital Timone, Marseille, France
| | - V Vermeersch
- Anaesthesiology and Intensive Care Unit, Brest University Hospital, Brest, France
| | - L Velly
- Aix Marseille University, AP-HM, Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Marseille, France
| | - H Quintard
- Intensive Care Unit, Nice University Hospital, Pasteur 2 Hospital, Nice, France
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Oshlag B, Ray T, Boswell B. Neck Injuries. Prim Care 2020; 47:165-176. [PMID: 32014132 DOI: 10.1016/j.pop.2019.10.009] [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: 11/26/2022]
Abstract
Neck injuries are relatively uncommon but have the potential to cause serious and permanent disability. In athletes, injuries are most common in contact sports, and occur with direct axial loading with a forward-flexed neck. Soft tissue and peripheral nerve injuries are typically minor and self-limiting, with excellent recovery potential and return to activities based on symptoms. Concern for devastating spinal cord injuries has led to routine immobilization using spine boards and hard cervical collars. This approach may provide more harm than benefit when applied universally, and a more commonsense protocol can be used to better address potential neck injuries.
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Affiliation(s)
- Benjamin Oshlag
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Hospital, First Ave at 16th St, New York, NY 10003, USA.
| | - Tracy Ray
- Duke Sports Medicine, Duke University, 3475 Erwin Rd, Durham, NC 27705, USA
| | - Benjamin Boswell
- Dvision of Sports Medicine, Primary Care Sports Medicine, Department of Orthopedic Surgery, Department of Emergency Medicine, Case Western Reserve University School of Medicine, University Hospitals Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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Cervical Spine Movement in a Cadaveric Model of Severe Spinal Instability: A Study Comparing Tracheal Intubation with 4 Different Laryngoscopes. J Neurosurg Anesthesiol 2020; 32:57-62. [DOI: 10.1097/ana.0000000000000560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hawkins SC, Williams J, Bennett BL, Islas A, Kayser DW, Quinn R. Wilderness Medical Society Clinical Practice Guidelines for Spinal Cord Protection. Wilderness Environ Med 2019; 30:S87-S99. [DOI: 10.1016/j.wem.2019.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/25/2019] [Accepted: 08/01/2019] [Indexed: 11/30/2022]
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[Development and first application testing of a new protocol for preclinical spinal immobilization in children : Assessment of indications based on the E.M.S. IMMO Protocol Pediatric]. Unfallchirurg 2019; 123:289-301. [PMID: 31768566 DOI: 10.1007/s00113-019-00744-y] [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: 10/25/2022]
Abstract
BACKGROUND To protect the spine from secondary damage, spinal immobilization is a standard procedure in prehospital trauma management. Immobilization protocols aim to support emergency medicine personnel in quick decision making but predominantly focus on the adult spine; however, trauma mechanisms and injury patterns in adults differ from those in children and applying adult prehospital immobilization protocols to pediatric patients may be insufficient. Adequate protocols for children with spinal injuries are currently unavailable. OBJECTIVE The aim of this study was (i) to develop a protocol that supports decision making for prehospital spinal immobilization in pediatric trauma patients based on evidence from current scientific literature and (ii) to perform a first analysis of the quality of results if the protocol is used by emergency personnel. MATERIAL AND METHODS Based on a structured literature search a new immobilization protocol was developed. Analysis of the quality of results was performed by a questionnaire containing four case scenarios in order to assess correct decision making. The decision about spinal immobilization was made without and with the utilization of the protocol. RESULTS The E.M.S. IMMO Protocol Pediatric was developed based on the literature. The analysis of the quality of results was performed involving 39 emergency medicine providers. It could be shown that if the E.M.S. IMMO Protocol Pediatric was used, the correct type of immobilization was chosen more frequently. A total of 38 out of 39 participants evaluated the protocol as helpful. CONCLUSION The E.M.S. IMMO Protocol Pediatric provides decision-making support whether pediatric spine immobilization is indicated with respect to the cardiopulmonary status of the patient. In a first analysis, the E.M.S. IMMO Protocol Pediatric improves decision making by emergency medical care providers.
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Gather A, Spancken E, Münzberg M, Grützner PA, Kreinest M. Spinal Immobilization in the Trauma Room - a Survey-Based Analysis at German Level I Trauma Centers. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2019; 158:597-603. [PMID: 31634951 DOI: 10.1055/a-1007-2092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Spinal immobilization is a standard procedure in daily out-of-hospital emergency care. Homogenous recommendations concerning the immobilization of trauma patients during the first therapy in the emergency department do not exist. The aim of the current study was the analysis of the existing strategies concerning spinal immobilization in German level I trauma centers by an internet-based survey. MATERIALS AND METHODS The current study is a survey-based analysis of the current strategies concerning spinal immobilization in all 107 level I trauma centers in Germany. The internet-based survey consists of 6 items asking about immobilization in the emergency department. RESULTS The return rate was 47.7%. In 14 (28.6%) level I trauma centers the patients remained immobilized on the immobilization tool used by the professional emergency care providers. In 19 (38.8%) level I trauma centers the patients were transferred to a stretcher with a soft positioning mattress on it. Patient transfer to a spineboard or to a TraumaMattress was performed in 11 (22.4%) and 7 (14.3%) level I trauma centers, respectively. Trauma patients were never transferred to a vacuum mattress. Cervical spine protection was most of the time performed by a cervical collar (n = 48; 98.0%). In general, the survey's participants were mainly satisfied (mean = 84/100) with the current strategy of spinal immobilization. The satisfaction was best if the spineboard is used. DISCUSSION Patient positioning during initial emergency therapy in the emergency department of German level I trauma centers is highly heterogenous. Besides complete full body immobilization, also the lack of any immobilization was reported by the survey's participants.
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Affiliation(s)
- Andreas Gather
- Department of Trauma Surgery and Orthopaedics, BG Klinik Ludwigshafen
| | - Elena Spancken
- Department of Trauma Surgery and Orthopaedics, BG Klinik Ludwigshafen
| | - Matthias Münzberg
- Department of Trauma Surgery and Orthopaedics, BG Klinik Ludwigshafen
| | | | - Michael Kreinest
- Department of Trauma Surgery and Orthopaedics, BG Klinik Ludwigshafen
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Maschmann C, Jeppesen E, Rubin MA, Barfod C. New clinical guidelines on the spinal stabilisation of adult trauma patients - consensus and evidence based. Scand J Trauma Resusc Emerg Med 2019; 27:77. [PMID: 31426850 PMCID: PMC6700785 DOI: 10.1186/s13049-019-0655-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/06/2019] [Indexed: 12/13/2022] Open
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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Affiliation(s)
- Christian Maschmann
- Emergency Department, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Anesthesiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Emergency Medical Services Copenhagen, University Copenhagen, Copenhagen, Denmark
| | - Elisabeth Jeppesen
- Norwegian Trauma Registry, Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Health Science, University of Stavanger, Stavanger, Norway
| | - Monika Afzali Rubin
- Cochrane Anesthesia & Cochrane Critical and Emergency Care Group, Copenhagen, Denmark
- Department of Anesthesiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Charlotte Barfod
- Emergency Medical Services Copenhagen, University Copenhagen, Copenhagen, Denmark
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Núñez-Patiño RA, Rubiano AM, Godoy DA. Impact of Cervical Collars on Intracranial Pressure Values in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Prospective Studies. Neurocrit Care 2019; 32:469-477. [DOI: 10.1007/s12028-019-00760-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Coggins A, Ebrahimi N, Kemp U, O'Shea K, Fusi M, Murphy M. A prospective evaluation of cervical spine immobilisation in low-risk trauma patients at a tertiary Emergency Department. Australas Emerg Care 2019; 22:69-75. [PMID: 31053486 DOI: 10.1016/j.auec.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/03/2019] [Accepted: 04/03/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND In the Emergency Department cervical spine immobilisation precautions are frequently used. There is controversy in regard to the balance of risks and benefits of routine immobilisation in conscious patients. METHODS A prospective multi-methods evaluation in a tertiary trauma referral centre. The objectives were to investigate current practices and rate of concordance with established international guidelines. A provider survey focused on current knowledge, skills and attitudes and was disseminated to nurses, doctors and paramedics treating trauma patients. Additionally, clinical data were collected on a cohort of immobilised trauma patients. Demographic data were analysed using SPSS and content analysis was completed by manifest coding. RESULTS The response rate to the survey was 85.2%. Interdisciplinary providers included nurses (n=46), doctors (n=68) and paramedics (n=41). Content analysis revealed a range of themes for improving care. Themes identified included improved application of guidelines, tailored use of equipment in low-risk patients, improved access to radiology results, and staff education. The series of five case vignettes provided to participants revealed a high level of variance in intended approaches to immobilisation. In the cohort of trauma patients (n=54), the median age was 54 years and the most common mechanism of injury was falls (40.7%). Median time spent with immobilisation was 325min. Adherence to a recognised decision tool was 35/54 (64.8%). Precautions were initiated by paramedics in 42/54 (77.8%). CONCLUSIONS Despite widespread dissemination of guidelines, observed approaches to patient immobilisation appear to be highly variable in this trauma centre. Reducing variation for low-risk patients is likely to improve the patient journey and minimise the risk of prolonged immobilisation. Further assessment of the causes of variation could define goals for targeted translational change.
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Affiliation(s)
- Andrew Coggins
- Department of Emergency Medicine, Westmead Hospital, Sydney, Australia.
| | - Nargus Ebrahimi
- Department of Emergency Medicine, Westmead Hospital, Sydney, Australia
| | - Ursula Kemp
- Department of Emergency Medicine, Westmead Hospital, Sydney, Australia
| | - Kelly O'Shea
- Department of Emergency Medicine, Westmead Hospital, Sydney, Australia
| | | | - Margaret Murphy
- Department of Emergency Medicine, Westmead Hospital, Sydney, Australia
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Sharwood LN, Dhaliwal S, Ball J, Burns B, Flower O, Joseph A, Stanford R, Middleton J. Emergency and acute care management of traumatic spinal cord injury: a survey of current practice among senior clinicians across Australia. BMC Emerg Med 2018; 18:57. [PMID: 30567501 PMCID: PMC6300889 DOI: 10.1186/s12873-018-0207-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/23/2018] [Indexed: 12/20/2022] Open
Abstract
Background To describe pre-hospital, emergency department and acute care assessment and management practices of senior clinicians for patients with acute traumatic spinal cord injury (TSCI) across Australia; and to describe clinical practice variation. Methods We used a descriptive, cross-sectional study design to survey senior clinicians (greater than 10 years practice in this field) caring for patients with acute TSCI. The assessment, management and referral practices of prehospital, emergency department/trauma and surgical expert clinicians, across prehospital, early hospital care, diagnostic imaging and haemodynamic management were surveyed. Results We invited 95 eligible senior clinicians; the response rate was 75%. Survey findings demonstrated overall lack of awareness or consistent use of evidence based published guidelines; many clinicians following ‘locally written’ or ‘no particular’ guideline. Practitioners were conflicted across multiple areas including patient assessment and diagnosis, treatment and transport decisions. Reported spinal immobilisation practices differed substantially, as did target setting for blood pressure; the majority of clinicians actively monitored risk of respiratory deterioration. Specialist care consult and specialist service bed availability was reported as problematic by more than one third of clinicians. Conclusions Unwarranted clinical practice variation is known to contribute to different health outcomes for patients with similar etiologies. Clinical practice guidelines offer evidence based, best practice standards, however are only effective if adopted throughout the healthcare system. Wide variability in acute care practices, pathways and timing to specialist centres for TSCI was evidenced by this survey despite seniority among clinicians. This devastating injury requires prompt, consistent, evidence based care from the moment of first responder. Improved outcomes for patients with TSCI would be more likely with standardised care across pre-hospital, emergency and acute care phases of care. Keywords Spinal Cord Injuries, Multiple Trauma, Practice Guideline, Treatment Outcome, Surveys and Questionnaires, Expert Testimony
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Affiliation(s)
- Lisa N Sharwood
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Clinical School, Sydney Medical School, University of Sydney, Reserve Road, St Leonards, NSW, 2065, Australia.
| | - Shelly Dhaliwal
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Clinical School, Sydney Medical School, University of Sydney, Reserve Road, St Leonards, NSW, 2065, Australia
| | - Jonathon Ball
- Department of Neurosurgery, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
| | - Brian Burns
- Greater Sydney Area Helicopter Emergency Medical Service, Bankstown, NSW, 2200, Australia
| | - Oliver Flower
- Intensive Care Department, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
| | - Anthony Joseph
- Department of Trauma, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
| | - Ralph Stanford
- Department of Orthopaedics, Prince of Wales Private Hospital, Barker Street, Randwick, NSW, 2031, Australia
| | - James Middleton
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Clinical School, Sydney Medical School, University of Sydney, Reserve Road, St Leonards, NSW, 2065, Australia
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Abstract
Since the early 1970s, initial management of patients with suspected spinal injuries has involved the use of a cervical collar and long spine board for full immobilization, which was thought to prevent additional injury to the cervical spine. Despite a growing body of literature demonstrating the detrimental effects and questionable efficacy of spinal immobilization, the practice continued until 2013, when the National Association of EMS Physicians issued a position statement calling for a reduction in the use of spinal immobilization and a shift to spinal-motion restriction. This article examines the literature that prompted the change in spinal-injury management and the virtual elimination of the long spine board as a tool for transport.
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Affiliation(s)
- Francis X Feld
- Anesthesia Department, University of Pittsburgh Medical Center Passavant Hospital, PA
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35
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Review of existing measurement tools to assess spinal motion during prehospital immobilization. Eur J Emerg Med 2018; 25:161-168. [DOI: 10.1097/mej.0000000000000467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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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-E1402. [PMID: 28591075 DOI: 10.1097/brs.0000000000002260] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A biomechanical cadaveric study. OBJECTIVE We sought to determine the amount of motion generated in an unstable cervical spine fracture with use of the vacuum mattress versus the spine board alone. Our hypothesis is that the vacuum mattress will better immobilize an unstable cervical fracture. SUMMARY OF BACKGROUND DATA Trauma patients in the United States are immobilized on a rigid spine board, whereas in many other places, vacuum mattresses are used with the proposed advantages of improved comfort and better immobilization of the spine. METHODS Unstable subaxial cervical injuries were surgically created in five fresh whole human cadavers. The amount of motion at the injured motion segment during testing was measured using a Fastrak, three-dimensional, electromagnetic motion analysis device (Polhemus Inc.). The measurements recorded in this investigation included maximum displacements during application and removal of the device, while tilting to 90°, during a bed transfer, and a lift onto a gurney. Linear and angular displacements were compared using the Generalized Linear Model analysis of variance for repeated measures for each of the six dependent variables (three planes of angulations and three axes of displacement). RESULTS There was more motion in all six planes of motion during the application process with use of the spine board alone, and this was statistically significant for axial rotation (P = 0.011), axial distraction (P = 0.035), medial-lateral translation (P = 0.027), and anteroposterior translation (P = 0.026). During tilting, there was more motion with just the spine board, but this was only statistically significant for anteroposterior translation (P = 0.033). With lifting onto the gurney, there was more motion with the spine board in all planes with statistical significance, except lateral bending. During the removal process, there was more motion with the spine board alone, and this was statistically significant for axial rotation (P = 0.035), lateral bending (P = 0.044), and axial distraction (P = 0.023). CONCLUSION There was more motion when using a spine board alone during typical maneuvers performed during early management of the spine injured patient than the vacuum mattress. There may be benefit of use of the vacuum mattress versus the spine board alone in preventing motion at an unstable, subaxial cervical spine injury. LEVEL OF EVIDENCE 2.
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Gather A, Beisemann N, Gebhard E, Gliwitzky B, Böttcher M, Geißert S, Swartman B, Kreinest M. Ruhigstellung von Frakturen in der präklinischen Notfallmedizin. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hyldmo PK, Horodyski M, Conrad BP, Aslaksen S, Røislien J, Prasarn M, Rechtine GR, Søreide E. Does the novel lateral trauma position cause more motion in an unstable cervical spine injury than the logroll maneuver? Am J Emerg Med 2017; 35:1630-1635. [PMID: 28511807 DOI: 10.1016/j.ajem.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/08/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Prehospital personnel who lack advanced airway management training must rely on basic techniques when transporting unconscious trauma patients. The supine position is associated with a loss of airway patency when compared to lateral recumbent positions. Thus, an inherent conflict exists between securing an open airway using the recovery position and maintaining spinal immobilization in the supine position. The lateral trauma position is a novel technique that aims to combine airway management with spinal precautions. The objective of this study was to compare the spinal motion allowed by the novel lateral trauma position and the well-established log-roll maneuver. METHODS Using a full-body cadaver model with an induced globally unstable cervical spine (C5-C6) lesion, we investigated the mean range of motion (ROM) produced at the site of the injury in six dimensions by performing the two maneuvers using an electromagnetic tracking device. RESULTS Compared to the log-roll maneuver, the lateral trauma position caused similar mean ROM in five of the six dimensions. Only medial/lateral linear motion was significantly greater in the lateral trauma position (1.4mm (95% confidence interval [CI] 0.4, 2.4mm)). CONCLUSIONS In this cadaver study, the novel lateral trauma position and the well-established log-roll maneuver resulted in comparable amounts of motion in an unstable cervical spine injury model. We suggest that the lateral trauma position may be considered for unconscious non-intubated trauma patients.
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Affiliation(s)
- Per Kristian Hyldmo
- Department of Research, Norwegian Air Ambulance Foundation, Drøbak, Norway; Trauma Unit, Sørlandet Hospital, Kristiansand, Norway.
| | - MaryBeth Horodyski
- Department of Orthopedics & Rehabilitation, University of Florida, Gainesville, Florida, USA.
| | - Bryan P Conrad
- Department of Orthopedics & Rehabilitation, University of Florida, Gainesville, Florida, USA; Nike Inc., Portland, Oregon, USA
| | - Sindre Aslaksen
- Division of EMS, Sørlandet Hospital, Kristiansand, Norway; Norwegian Air Ambulance, Drøbak, Norway.
| | - Jo Røislien
- Department of Health Studies, University of Stavanger, Stavanger, Norway.
| | - Mark Prasarn
- Department of Orthopedics, University of Texas, Huston, Texas, USA.
| | - Glenn R Rechtine
- Bay Pines VAHCS, Bay Pines, Florida, USA; University of South Florida, Tampa, Florida, USA
| | - Eldar Søreide
- Stavanger University Hospital, Stavanger, Norway; Network for Medical Sciences, University of Stavanger, Stavanger, Norway.
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Kornhall DK, Jørgensen JJ, Brommeland T, Hyldmo PK, Asbjørnsen H, Dolven T, Hansen T, Jeppesen E. The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury. Scand J Trauma Resusc Emerg Med 2017; 25:2. [PMID: 28057029 PMCID: PMC5217292 DOI: 10.1186/s13049-016-0345-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/12/2016] [Indexed: 11/10/2022] Open
Abstract
The traditional prehospital management of trauma victims with potential spinal injury has become increasingly questioned as authors and clinicians have raised concerns about over-triage and harm. In order to address these concerns, the Norwegian National Competence Service for Traumatology commissioned a faculty to provide a national guideline for pre-hospital spinal stabilisation. This work is based on a systematic review of available literature and a standardised consensus process. The faculty recommends a selective approach to spinal stabilisation as well as the implementation of triaging tools based on clinical findings. A strategy of minimal handling should be observed.
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Affiliation(s)
- Daniel K Kornhall
- East Anglian Air Ambulance, Cambridge, UK. .,Department of Acute Medicine, Nordland Central Hospital, Postboks 1480, 8092, Bodø, Norway. .,Swedish Air Ambulance, Mora, Sweden.
| | - Jørgen Joakim Jørgensen
- Department of Traumatology, Oslo University Hospital, Oslo, Norway.,Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
| | - Tor Brommeland
- Neurosurgical Department, Oslo University Hospital, Oslo, Norway
| | - Per Kristian Hyldmo
- Trauma Unit, Sørlandet Hospital, Kristiansand, Norway.,Department of Research, Norwegian Air Ambulance Foundation, Drøbak, Norway
| | - Helge Asbjørnsen
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Helicopter Emergency Medical Services, Bergen, Norway
| | - Thomas Dolven
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Thomas Hansen
- Emergency Medical Services, University Hospital of North Norway, Tromsø, Norway
| | - Elisabeth Jeppesen
- Norwegian National Advisory Unit on Trauma, Oslo University Hospital, Oslo, Norway.,Department of Health Studies, University of Stavanger, Stavanger, Norway
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Kreinest M, Scholz M, Trafford P. On-scene treatment of spinal injuries in motor sports. Eur J Trauma Emerg Surg 2016; 43:191-200. [PMID: 28005155 DOI: 10.1007/s00068-016-0749-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 12/12/2016] [Indexed: 12/18/2022]
Abstract
Because spinal cord injuries can have fatal consequences for injured race car drivers, prehospital treatment of spinal injuries is a major concern in motor sports. A structured procedure for assessing trauma patients and their treatment should follow established ABCDE principles. Only then, a stable patient could be further examined and appropriate measures can be undertaken. For patients in an acute life-threatening condition, rapid transport must be initiated and should not be delayed by measures that are not indicated. If a competitor must first be extricated from the racing vehicle, the correct method of extrication must be chosen. To avoid secondary injury to the spine after a racing accident, in-line extrication from the vehicle and immobilization of the patient are standard procedures in motor sports and have been used for decades. Since immobilization can be associated with disadvantages and complications, the need for immobilization of trauma patients outside of motor sports medicine has become the subject of an increasing number of reports in the scientific literature. Even in motor sports, where specific safety systems that offer spinal protection are present, the indications for spinal immobilization need to be carefully considered rather than being blindly adopted as a matter of course. The aim of this article is to use recent literature to present an overview about the treatment of spinal injuries in motor sports. Further, we present a new protocol for indications for immobilizing the spine in motor sports that is based on the ABCDE principles and takes into account the condition of the patient.
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Affiliation(s)
- M Kreinest
- Department for Trauma Surgery, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
| | - M Scholz
- Department for Orthopedics and Anesthesia, Specialty Hospital Vogelsang-Gommern, Sophie-v.-Boetticher-Straße 1, 39245, Gommern, Germany
| | - P Trafford
- Department of Anesthesia, Arrowe Park Hospital, Arrowe Park Road, Upton, United Kingdom
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[Spinaltrauma : Clinical diagnosis and initial care]. Radiologe 2016; 56:684-90. [PMID: 27325345 DOI: 10.1007/s00117-016-0120-z] [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: 10/21/2022]
Abstract
DIAGNOSTIC WORK-UP The rescue, treatment and transport of patients with an injured spine require a systematic scheme with the subsequent rating of the findings and suspected diagnoses. In addition to the assessment of temporal urgency, the available resources and personnel, the duration and complexity of any possible technical measures that might be anticipated, the rational selection of immobilisation tools also plays a significant role. The most important medical rescue aids are the scoop stretcher and the spine board; the spine board, vacuum mattress and cervical collar are used to immobilise the patient. PRACTICAL RECOMMENDATIONS This article is focused on the diagnosis and initial treatment of isolated spinal injuries. The prehospital care of polytraumatised patients and/or those with multiple injuries differs significantly and has different priorities.
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Kreinest M, Gliwitzky B, Grützner PA, Münzberg M. Untersuchung der Anwendbarkeit eines neuen Protokolls zur Immobilisation der Wirbelsäule. Notf Rett Med 2016. [DOI: 10.1007/s10049-016-0154-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Analysis of prehospital care and emergency room treatment of patients with acute traumatic spinal cord injury: a retrospective cohort study on the implementation of current guidelines. Spinal Cord 2016; 55:16-19. [DOI: 10.1038/sc.2016.84] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/05/2016] [Accepted: 04/10/2016] [Indexed: 11/08/2022]
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Kreinest M, Gliwitzky B, Schüler S, Grützner PA, Münzberg M. Development of a new Emergency Medicine Spinal Immobilization Protocol for trauma patients and a test of applicability by German emergency care providers. Scand J Trauma Resusc Emerg Med 2016; 24:71. [PMID: 27180045 PMCID: PMC4867978 DOI: 10.1186/s13049-016-0267-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/10/2016] [Indexed: 12/24/2022] Open
Abstract
Background In order to match the challenges of quickly recognizing and treating any life-threatening injuries, the ABCDE principles were established for the assessment and treatment of trauma patients. The high priority of spine protection is emphasized by the fact that immobilization of the cervical spine is performed at the very first step in the ABCDE principles. Immobilization is typically performed to prevent or minimize secondary damage to the spinal cord if instability of the spinal column is suspected. Due to increasing reports about disadvantages of spinal immobilization, the indications for performing spinal immobilization must be refined. The aim of this study was (i) to develop a protocol that supports decision-making for spinal immobilization in adult trauma patients and (ii) to carry out the first applicability test by emergency medical personnel. Methods A structured literature search considering the literature from 1980 to 2014 was performed. Based on this literature and on the current guidelines, a new protocol that supports on scene decision-making for spinal immobilization has been developed. Parameters found in the literature concerning mechanisms and factors increasing the likelihood of spinal injury have been included in the new protocol. In order to test the applicability of the new protocol two surveys were performed on German emergency care providers by means of a questionnaire focused on correct decision-making if applying the protocol. Results Based on the current literature and guidelines, the Emergency Medicine Spinal Immobilization Protocol (E.M.S. IMMO Protocol) for adult trauma patients was developed. Following a fist applicability test involving 21 participants, the first version of the E.M.S. IMMO Protocol has to be graphically re-organized. A second applicability test comprised 50 participants with the current version of the protocol confirmed good applicability. Questions regarding immobilization of trauma patients could be answered properly using the E.M.S. IMMO Protocol. Discussion Current literature increasingly reports of disadvantages that may be associated with immobilization. Based on the requirements of the current guidelines, a new protocol that supports decision-making for indications for out-of-hospital spinal immobilization has been developed in this study. In contrast to established protocols, the new protocol offers different options for immobilization as well as a decicion-support. Conclusions The E.M.S. IMMO protocol provides a decision-support tool for indications for spinal immobilization in adult trauma patients that permits variable decision-making depending on the current condition of the trauma patient and the pattern of injuries for immobilization in general and for immobilization method in particular.
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Affiliation(s)
- Michael Kreinest
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.,PHTLS Europe Research Group, Offenbach/Queich, Germany
| | | | - Svenja Schüler
- University of Heidelberg, Institute for Medical Biometry and Informatics, Heidelberg, Germany
| | - Paul A Grützner
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Matthias Münzberg
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany. .,PHTLS Europe Research Group, Offenbach/Queich, Germany.
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Karimi MT, Kamali M, Fatoye F. Evaluation of the efficiency of cervical orthoses on cervical fracture: A review of literature. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2016; 7:13-9. [PMID: 27041880 PMCID: PMC4790142 DOI: 10.4103/0974-8237.176611] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Various methods have been used to stabilize the vertebra in cervical fractures, including the use of various orthoses and surgery. However, it is not cleared which type of orthosis is more suitable for the subjects with cervical fractures to best immobilize the vertebra and to decrease the associated side effects. Therefore, the aim of this study was to evaluate the efficiency of various orthoses based on the available literature. Materials and Methods: A search was done in some databases include PubMed, ISI Web of Knowledge, EBSCO, Embasco, and Google Scholar. The search was done with some key words such as: Cervical spine injuries; odontoid fractures; hangman's fractures; axis fracture; axis, atlas, cervical fractures; trauma; neck fracture; neck injury in combination with cervical orthoses. The quality of the studies was evaluated by use of Downs and Black assessment and Assessment of Multiple Systematic Reviews (AMSTAR) for original research and review articles, respectively. Results: Based on the aforementioned key words, 25 papers were selected. The quality of the studies varies 10-24. Most of the studies were on the use of the halo vest orthosis, its side effects and also on complications associated with various orthoses. Discussion: Halo orthoses provide a high degree of restriction and immobilization; however, there are some side effects associated with this orthosis, including swallowing, pin loosening, and infection. It should be emphasized that other types of orthoses fewer complications, with reasonable outputs on motion restrictions.
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Affiliation(s)
- Mohammad Taghi Karimi
- Department of Orthotics and Prosthetics, Rehabilitation Faculty, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mostafa Kamali
- Department of Orthotics and Prosthetics, Rehabilitation Faculty, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Francis Fatoye
- Department of Health Professions, Manchester Metropolitan University, United Kingdom
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Singletary EM, Zideman DA, De Buck EDJ, Chang WT, Jensen JL, Swain JM, Woodin JA, Blanchard IE, Herrington RA, Pellegrino JL, Hood NA, Lojero-Wheatley LF, Markenson DS, Yang HJ. Part 9: First Aid: 2015 International Consensus on First Aid Science With Treatment Recommendations. Circulation 2016; 132:S269-311. [PMID: 26472857 DOI: 10.1161/cir.0000000000000278] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Characteristics of Trauma Patients With Potential Cervical Spine Injuries Underimmobilized by Prehospital Providers. Spine (Phila Pa 1976) 2015; 40:1898-902. [PMID: 26352743 DOI: 10.1097/brs.0000000000001149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This study was a retrospective chart review to determine characteristics of patients under-immobilized by prehospital providers. OBJECTIVE Our goal was to examine the characteristics of patients who met the criteria for spinal immobilization but were inappropriately cleared. SUMMARY OF BACKGROUND DATA Many emergency medical services (EMS) use selective spinal immobilization (SSI) based on the NEXUS criteria. However, there is been research examining patients who are under-immobilized by EMS. METHODS This was a retrospective chart review over 18 months of a single EMS service. We reviewed all charts dispatched as "motor vehicle crash" (MVC) or "fall". We then determined, whether the patient met the criteria for SSI under Pennsylvania protocols, which mirror the NEXUS criteria. RESULTS Our EMS system responded to 1151 falls and MVCs over the study period. Seventy-six patients were immobilized leaving 1075 patients who had clinical clearance of their cervical spine. Of these patients, 4/1075 (0.3%) were considered to be under-immobilized. All 4 of these patients had intoxication or altered mentation mentioned in their charts. Two of these patients had CT scans of their cervical spine, with both being negative. One patient eloped from the ED before any imaging, and 1 patient was clinically cleared. CONCLUSION EMTs are very proficient in following the SSI guidelines with an under-immobilization rate of approximately 0.3% in our study. However, all patients who were under-immobilized were under the influence of alcohol. There were no patients who were not immobilized and had cervical spine injuries. This was a limited chart review involving only 2 dispatch categories. EMTs should be cautious while evaluating patients with possible spinal injuries who are under the influence of alcohol. LEVEL OF EVIDENCE 4.
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Prasarn ML, Horodyski M, DiPaola MJ, DiPaola CP, Del Rossi G, Conrad BP, Rechtine GR. Controlled Laboratory Comparison Study of Motion With Football Equipment in a Destabilized Cervical Spine: Three Spine-Board Transfer Techniques. Orthop J Sports Med 2015; 3:2325967115601853. [PMID: 26535397 PMCID: PMC4622296 DOI: 10.1177/2325967115601853] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Numerous studies have shown that there are better alternatives to log rolling patients with unstable spinal injuries, although this method is still commonly used for placing patients onto a spine board. No previous studies have examined transfer maneuvers involving an injured football player with equipment in place onto a spine board. Purpose To test 3 different transfer maneuvers of an injured football player onto a spine board to determine which method most effectively minimizes spinal motion in an injured cervical spine model. Study Design Controlled laboratory study. Methods Five whole, lightly embalmed cadavers were fitted with shoulder pads and helmets and tested both before and after global instability was surgically created at C5-C6. An electromagnetic motion analysis device was used to assess the amount of angular and linear motion with sensors placed above and below the injured segment during transfer. Spine-boarding techniques evaluated were the log roll, the lift and slide, and the 8-person lift. Results The 8-person lift technique resulted in the least amount of angular and linear motion for all planes tested as compared with the lift-and-slide and log-roll techniques. This reached statistical significance for lateral bending (P = .031) and medial-lateral translation (P = .030) when compared with the log-roll maneuver. The lift-and-slide technique was significantly more effective at reducing motion than the log roll for axial rotation (P = .029) and lateral bending (P = .006). Conclusion The log roll resulted in the most motion at an unstable cervical injury as compared with the other 2 spine-boarding techniques examined. The 8-person lift and lift-and-slide techniques may both be more effective than the log roll at reducing unwanted cervical spine motion when spine boarding an injured football player. Reduction of such motion is critical in the prevention of iatrogenic injury.
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Affiliation(s)
- Mark L Prasarn
- Department of Orthopaedics, University of Texas, Houston, Texas, USA
| | - MaryBeth Horodyski
- Department of Orthopaedics, University of Florida, Gainesville, Florida, USA
| | - Matthew J DiPaola
- Department of Orthopaedics, Wright State University, Dayton VA Medical Center, Dayton, Ohio, USA
| | | | - Gianluca Del Rossi
- Department of Orthopaedics, University of South Florida, Tampa, Florida, USA
| | - Bryan P Conrad
- Department of Orthopaedics, University of Florida, Gainesville, Florida, USA
| | - Glenn R Rechtine
- Department of Orthopaedics, VA Medical Center, Asheville, North Carolina, USA
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