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Mitra B, Bernard S, Yankoff C, Somesh A, Stewart C, Koolstra C, Talarico C, Nehme Z, Fitzgerald MC, Cameron PA. Change from semi-rigid to soft collars for prehospital management of trauma patients: An observational study. J Am Coll Emerg Physicians Open 2024; 5:e13239. [PMID: 39027351 PMCID: PMC11255016 DOI: 10.1002/emp2.13239] [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: 02/20/2024] [Revised: 06/15/2024] [Accepted: 06/25/2024] [Indexed: 07/20/2024] Open
Abstract
Objectives Protection of the cervical spine is recommended following multisystem injury. In 2021, Ambulance Victoria changed clinical practice guidelines to apply soft collars instead of semi-rigid collars for suspected cervical spine injury. The aim of this study was to describe associated changes in imaging practices and diagnoses of pressure sores, hospital acquired pneumonia, and spinal cord injury. Methods A retrospective pre- and postintervention study was conducted including all consecutive patients that presented to an adult major trauma center in Melbourne, Australia with a cervical collar placed by emergency medical services over two 3-month periods. Results There were 1762 patients included. A computed tomography (CT) of the cervical spine was performed in 795 (88.4%) patients in the semi-rigid collar period and 810 (93.8%) in the soft collar period (p = 0.001). Soft collars were associated with higher rates of clearance of the cervical spine in the emergency department (ED) (odds ratio [OR] 4.14; 95% confidence interval [CI]: 3.36-5.09). There were no differences in diagnosis of pressure sores (0.11% vs. 0.23%, p = 0.97) or hospital acquired pneumonia (2.0% vs. 2.7%; p = 0.44) or cervical spinal cord injury (0.45% vs. 0.81%; p = 0.50). Conclusions Following a change from prehospital semi-rigid collars to soft collars, more patients were investigated with a CT scan and more frequent clearance of the cervical spine occurred in the ED. There were no differences in the rates of spinal cord injuries, pressure sores or hospital acquired pneumonia, but the study was underpowered to detect significant differences. The practice of soft collars for prehospital care of patients with suspected neck injury requires ongoing surveillance.
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Affiliation(s)
- Biswadev Mitra
- Emergency & Trauma CentreAlfred HealthMelbourneVictoriaAustralia
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Stephen Bernard
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Ambulance VictoriaMelbourneVictoriaAustralia
| | - Cassandra Yankoff
- Emergency & Trauma CentreAlfred HealthMelbourneVictoriaAustralia
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Abha Somesh
- Emergency & Trauma CentreAlfred HealthMelbourneVictoriaAustralia
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Cara Stewart
- Emergency & Trauma CentreAlfred HealthMelbourneVictoriaAustralia
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Christine Koolstra
- Emergency & Trauma CentreAlfred HealthMelbourneVictoriaAustralia
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Carly Talarico
- Emergency & Trauma CentreAlfred HealthMelbourneVictoriaAustralia
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Ziad Nehme
- Ambulance VictoriaMelbourneVictoriaAustralia
| | - Mark C. Fitzgerald
- Ambulance VictoriaMelbourneVictoriaAustralia
- Trauma ServiceAlfred HealthMelbourneVictoriaAustralia
- National Trauma Research InstituteAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Peter A. Cameron
- Emergency & Trauma CentreAlfred HealthMelbourneVictoriaAustralia
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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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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Dion PM, Lapierre M, Said H, Tremblay S, Tariq K, Lamb T, English SW, Kingstone M, Stratton A, Boet S, Shorr R, Lampron J. Rethinking cervical spine clearance in obtunded trauma patients: An updated systematic review and meta-analysis. Injury 2024; 55:111308. [PMID: 38266326 DOI: 10.1016/j.injury.2023.111308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/23/2023] [Accepted: 12/29/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Cervical spine injuries (CSI) are often challenging to diagnose in obtunded adult patients with blunt trauma and the optimal imaging modality remains uncertain. This study systematically synthesized the last decade of evidence to determine the type of imaging required to clear the c-spine in obtunded patients with blunt trauma. METHODS A systematic review with meta-analysis was conducted and reported using PRISMA 2020 guidelines. The protocol was registered on June 22, 2022 (PROSPERO CRD42022341386). MEDLINE (Ovid), EMBASE, and Cochrane Library were searched for studies published between January 1, 2012, and October 17, 2023. Studies comparing CT alone to CT combined with MRI for c-spine clearance were included. Two independent reviewers screened articles for eligibility in duplicate. Meta-analysis was conducted using a random-effect model. Risk of bias and quality assessment were performed using the ROBINS-I and QUADAS-2. The certainty of evidence was assessed using the GRADE methodology. RESULTS 744 obtunded trauma patients from six included studies were included. Among the 584 that had a negative CT scan, the pooled missed rate of clinically significant CSI using CT scans alone was 6 % (95 % CI: 0.02 to 0.17), and the pooled missed rate of CSI requiring treatment was 7 % (95 % CI: 0.02 to 0.18). High heterogeneity was observed among included studies (I² > 84 %). The overall risk of bias was moderate, and the quality of evidence was low due to the retrospective nature of the included studies and high heterogeneity. CONCLUSIONS Limited evidence published in the last decade found that CT scans alone may not be sufficient for detecting clinically significant CSI and injuries requiring treatment in obtunded adult patients with blunt trauma. IMPLICATIONS OF KEY FINDINGS Clinicians should be aware of the limitations of CT scans and consider using MRI when appropriate. Future research should focus on prospective studies with standardized outcome measures and uniform reporting.
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Affiliation(s)
- Pierre-Marc Dion
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Hussein Said
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sophie Tremblay
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Khadeeja Tariq
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tyler Lamb
- Division of General Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Shane W English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine (Critical Care), The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Michael Kingstone
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Alexandra Stratton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Orthopedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Sylvain Boet
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada; Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada
| | - Risa Shorr
- Library Services, The Ottawa Hospital, Ottawa, ON, Canada
| | - Jacinthe Lampron
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of General Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
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Cardona S, Hernández C, Bohórquez-Tarazona MP, Rubiano AM, Parra DMS. Scalp wound management: a narrative review from a neurosurgical perspective. J Wound Care 2024; 33:127-135. [PMID: 38329834 DOI: 10.12968/jowc.2024.33.2.127] [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: 02/10/2024]
Abstract
OBJECTIVE This article aims to present a narrative review of current literature about the anatomical characteristics of the scalp as well as current practices in the management of surgical, traumatic and pressure injuries in the scalp, which are common in neurosurgery practice. METHOD We searched PubMed for publications and book chapters in English from 2011 to 2021. We also included commonly referenced papers that we considered relevant to the subject with publication before these dates. We used the search terms 'laceration,' and/or 'neurosurgery' and/or, 'pressure injury,' and/or 'craniotomy,' and/or 'surgical incision' in combination with 'scalp,' and/or 'wound care.' We also searched the reference lists of publications identified by the search strategy and selected those that we judged relevant. RESULTS We pre-selected 52 articles that covered various aspects of anatomy, pathophysiology, scalp wound management, or general wound care that we considered applied to the anatomical region of our interest. After abstract review, we selected 34 articles that met our search criteria and were included in our review. CONCLUSION There is limited evidence regarding classification and care of scalp wounds. As a result, many of the current practices for scalp wound management are based on evidence derived from studies involving different anatomical regions, not considering its particular anatomy, vasculature and microbiome. Further research is needed for more comprehensive and effective protocols for the management of scalp injuries. However, this present review proposes responses to the identified gaps concerning the management of scalp wounds.
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Affiliation(s)
| | | | | | - Andrés M Rubiano
- Meditech Foundation, Barrow Neurological Institute at Phoenix Children's Hospital, US
- Valle Salud IPS Clinic Network, Colombia
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, UK
| | - Diana Marcela Sánchez Parra
- Meditech Foundation, Barrow Neurological Institute at Phoenix Children's Hospital, US
- Fellow, Global Neurosurgery and Trauma, University of Cambridge, UK
- Fundación Meditech, Cali, Colombia
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Kohta M, Yunoki S, Sugama J. Effect of prophylactic dressings to reduce pressure injuries: a polymer-based skin model. J Wound Care 2024; 33:S4-S9. [PMID: 38348862 DOI: 10.12968/jowc.2024.33.sup2.s4] [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: 02/15/2024]
Abstract
OBJECTIVE This study evaluated the effect of pressure injury (PI) prophylactic dressings used for patients at high risk of PI development to reduce friction, shear force and pressure, and their combined force, in an original polymer-based skin model. METHOD A low-friction outer-layer hydrocolloid (LFH) dressing and a multilayered silicone foam (MSF) dressing were used. Before application, compression and friction properties were measured. Our original experimental model-the 'simulated skin-shearing test'-consisted of: a weight; a polyurethane-based skin model containing a three-axis tactile sensor; dressings; a table covered with bedsheets; and a mechanical tester, by which the interface friction force, internal shear force and pressure were measured continuously during skin model movements. An estimated combined force generated by internal shear and pressure was represented as a vector. A model with no dressing was used as a control. RESULTS The LFH dressing had significantly higher compression strength versus the MSF dressing. In contrast, the dynamic coefficient of friction was lower for the LFH dressing versus the MSF dressing (p<0.05). In simulated skin-shearing test results, shear forces were 0.45N and 0.42N for LFH and MSF dressings, respectively, with no significant difference. The estimated combined force was lower for the MSF dressing compared with that of the LFH dressing and control. CONCLUSION The shear force-reducing effect in the skin model was equivalent between the LFH and MSF dressings. However, the MSF dressing significantly reduced the force generated by a combination of internal shear force and pressure compared with the LFH dressing.
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Affiliation(s)
- Masushi Kohta
- Research Center for Implementation Nursing Science Initiative, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Shunji Yunoki
- Biotechnology Group, Tokyo Metropolitan Industrial Technology Research Institute, Tokyo, Japan
| | - Junko Sugama
- Research Center for Implementation Nursing Science Initiative, School of Health Sciences, Fujita Health University, Aichi, Japan
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Melhado C, Russell KW, Acker SN, Padilla BE, Lofberg K, Spurrier RG, Robinson B, Chao S, Ignacio RC, Ryan M, Jensen AR. Cervical Collar-Associated Pressure Injury in Pediatric Trauma Patients: A Western Pediatric Surgery Research Consortium Study. J Pediatr Surg 2024; 59:326-330. [PMID: 38030530 DOI: 10.1016/j.jpedsurg.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Healthcare-associated pressure injuries (HAPI) are known to be associated with medical devices and are preventable. Cervical spine immobilization is commonly utilized in injured children prior to clinical clearance or for treatment of an unstable cervical spinal injury. The frequency of HAPI has been quantified in adults with cervical spine immobilization but has not been well-described in children. The aim of this study was to describe characteristics of children who developed HAPI associated with cervical immobilization. METHODS We analyzed a retrospective cohort of children (0-18 years) who developed a stage two or greater cervical HAPI. This cohort was drawn from an overall sample of 49,218 registry patients treated over a five-year period (2017-2021) at ten pediatric trauma centers. Patient demographics, injury characteristics, and cervical immobilization were tabulated to describe the population. RESULTS The cohort included 32 children with stage two or greater cervical HAPI. The median age was 5 years (IQR 2-13) and 78% (n = 25) were admitted to the intensive care unit. The median (IQR) time to diagnosis of HAPI was 11 (7-21) days post-injury. The majority of cervical HAPI (78%, 25/32) occurred in children requiring immobilization for cervical injuries, with only four children developing HAPI after wearing a prophylactic cervical collar in the absence of a cervical spine injury. CONCLUSION Advanced-stage HAPI associated with cervical collar use in pediatric trauma patients is rare and usually occurs in patients with cervical spine injuries requiring immobilization for treatment. More expedient cervical spine clearance with MRI is unlikely to substantially reduce cervical HAPI in injured children. LEVEL OF EVIDENCE Level III (Epidemiologic and Prognostic).
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Affiliation(s)
- Caroline Melhado
- University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA.
| | | | | | | | | | | | - Bryce Robinson
- University of Washington School of Medicine, Seattle, WA, USA.
| | | | | | - Mark Ryan
- University of Texas Southwestern, Dallas, TX, USA.
| | - Aaron R Jensen
- University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA.
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Raisch P, Pflästerer J, Kreinest M, Vetter SY, Grützner PA, Jung MK. Secondary Dislocations in Type B and C Injuries of the Subaxial Cervical Spine: Risk Factors and Treatment. J Clin Med 2024; 13:700. [PMID: 38337392 PMCID: PMC10856098 DOI: 10.3390/jcm13030700] [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: 11/25/2023] [Revised: 01/07/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION This study analyzed the incidence of secondary dislocations (sDLs) after surgical stabilization of AO Spine type B and C injuries of the subaxial cervical spine (sCS). MATERIALS AND METHODS Patients treated for injuries of the sCS from 2010 to 2020 were retrospectively analyzed for the incidence of sDL within 60 days after first surgery. A univariate analysis of variables potentially influencing the risk of sDL was performed. Patients with solitary anterior stabilization underwent subgroup analysis. The treatment of sDLs was described. RESULTS A total of 275 patients were included. sDLs occurred in 4.0% of patients (n = 11) in the total sample, most frequently after solitary anterior stabilization with 8.0% (n = 10, p = 0.010). Only one sDL occurred after combined stabilization and no sDLs after posterior stabilization. In the total sample and the anterior subgroup, variables significantly associated with sDL were older age (p = 0.001) and concomitant unstable facet joint injury (p = 0.020). No neurological deterioration occurred due to sDL and most patients were treated with added posterior stabilization. sDL is frequent after solitary anterior stabilization and rare after posterior or combined stabilization. DISCUSSION Patients of higher age and with unstable facet joint injuries should be followed up diligently to detect sDLs in time. Neurological deterioration does not regularly occur due to sDL, and most patients can be treated with added posterior stabilization.
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Affiliation(s)
| | | | | | | | | | - Matthias K. Jung
- Department for Trauma and Orthopaedic Surgery, University of Heidelberg, BG Klinik Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; (P.R.); (J.P.); (M.K.); (S.Y.V.); (P.A.G.)
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8
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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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Russell KW, Iantorno SE, Iyer RR, Brockmeyer DL, Smith KM, Polukoff NE, Larsen KE, Barnes KL, Bell TM, Fenton SJ, Inaba K, Swendiman RA. Pediatric cervical spine clearance: A 10-year evaluation of multidetector computed tomography at a level 1 pediatric trauma center. J Trauma Acute Care Surg 2023; 95:354-360. [PMID: 37072884 DOI: 10.1097/ta.0000000000003929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Efficient and accurate evaluation of the pediatric cervical spine (c-spine) for both injury identification and posttraumatic clearance remains a challenge. We aimed to determine the sensitivity of multidetector computed tomography (MDCT) for identification of cervical spine injuries (CSIs) in pediatric blunt trauma patients. METHODS A retrospective cohort study was conducted at a level 1 pediatric trauma center from 2012 to 2021. All pediatric trauma patients age younger than 18 years who underwent c-spine imaging (plain radiograph, MDCT, and/or magnetic resonance imaging [MRI]) were included. All patients with abnormal MRIs but normal MDCTs were reviewed by a pediatric spine surgeon to assess specific injury characteristics. RESULTS A total of 4,477 patients underwent c-spine imaging, and 60 (1.3%) were diagnosed with a clinically significant CSI that required surgery or a halo. These patients were older, more likely to be intubated, have a Glasgow Coma Scale score of <14, and more likely to be transferred in from a referring hospital. One patient with a fracture on radiography and neurologic symptoms got an MRI and no MDCT before operative repair. All other patients who underwent surgery including halo placement for a clinically significant CSI had their injury diagnosed by MDCT, representing a sensitivity of 100%. There were 17 patients with abnormal MRIs and normal MDCTs; none underwent surgery or halo placement. Imaging from these patients was reviewed by a pediatric spine surgeon, and no unstable injuries were identified. CONCLUSION Multidetector computed tomography appears to have 100% sensitivity for detecting clinically significant CSIs in pediatric trauma patients, regardless of age or mental status. Forthcoming prospective data will be useful to confirm these results and inform recommendations for whether pediatric c-spine clearance can be safely performed based on the results of a normal MDCT alone. LEVEL OF EVIDENCE Diagnostic Tests or Criteria; Level IV.
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Affiliation(s)
- Katie W Russell
- From the Division of Pediatric Surgery, Department of Surgery (K.W.R., S.E.I., K.M.S., N.E.P., K.E.L., T.M.B., S.J.F., R.A.S.) and Department of Neurosurgery (R.R.I., D.L.B.), University of Utah, Salt Lake City, Utah; Primary Children's Hospital, Salt Lake City, UT (K.L.B.); and Division of Trauma and Surgical Critical Care, Department of Surgery (K.I.), University of Southern California, Los Angles, CA
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10
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van de Breevaart OJ, van der Waarden NWPL, Schoonhoven L, Ham WHW, Schep NWL. Patient outcomes before and after implementation of a selective pre-hospital spinal immobilization protocol: A comparative cohort pilot study in a level 2 trauma center. Int Emerg Nurs 2023; 70:101345. [PMID: 37714056 DOI: 10.1016/j.ienj.2023.101345] [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: 03/20/2023] [Revised: 07/25/2023] [Accepted: 08/12/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND A new selective preventive spinal immobilization (PSI) protocol was introduced in the Netherlands. This may have led to an increase in non-immobilized spinal fractures (NISFs) and consequently adverse patient outcomes. AIM A pilot study was conducted to describe the adverse patient outcomes in NISF of the PSI protocol change and assess the feasibility of a larger effect study. METHODS Retrospective comparative cohort pilot study including records of trauma patients with a presumed spinal injury who were presented at the emergency department of a level 2 trauma center by the emergency medical service (EMS). The pre-period 2013-2014 (strict PSI protocol), was compared to the post-period 2017-2018 (selective PSI protocol). Primary outcomes were the percentage of records with a NISF who had an adverse patient outcome such as neurological injuries and mortality before and after the protocol change. Secondary outcomes were the sample size calculation for a larger study and the feasibility of data collection. RESULTS 1,147 records were included; 442 pre-period, and 705 post-period. The NISF-prevalence was 10% (95% CI 7-16, n = 19) and 8% (95% CI 6-11, n = 33), respectively. In both periods, no neurological injuries or mortality due to NISF were found, by which calculating a sample size is impossible. Data collection showed to be feasible. CONCLUSIONS No neurological injuries or mortality due to NISF were found in a strict and a selective PSI protocol. Therefore, a larger study is discouraged. Future studies should focus on which patients really profit from PSI and which patients do not.
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Affiliation(s)
| | | | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, United Kingdom.
| | - Wietske H W Ham
- HU University of Applied Sciences Utrecht, Utrecht, the Netherlands.
| | - Niels W L Schep
- Emergency Department, Maasstad Hospital, Rotterdam, the Netherlands.
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Zak M, Wasik M, Sikorski T, Aleksandrowicz K, Miszczuk R, Courteix D, Dutheil F, Januszko-Szakiel A, Brola W. Rehabilitation in Older Adults Affected by Immobility Syndrome, Aided by Virtual Reality Technology: A Narrative Review. J Clin Med 2023; 12:5675. [PMID: 37685741 PMCID: PMC10488935 DOI: 10.3390/jcm12175675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Individual mobility deficit in older adults induces a variety of medical conditions, diminishing their functional capacity in pursuing activities of daily living. In immobility syndrome patients, such conditions are prone further deterioration through a drastically reduced scope of physical activity, owing mostly to poor self-motivation and the monotonous character of conventional rehabilitation regimens. As evidenced by published research, virtual reality technology solutions in rehabilitation management actually add significantly to patients' self-motivation, while promoting their active involvement in therapy through visual, auditory, and kinaesthetic stimuli. Effective rehabilitation training aided by virtual reality solutions helps patients acquire specific physical and cognitive skills to be subsequently emulated in the real-world environment. The extra added advantage lies in facilitating such training within patients' own home environments, combined with online monitoring of their progress, when not personally supervised by a physiotherapist, which also boosts the overall cost effectiveness of the therapeutic management itself. This narrative review appears to be the very first one principally focused on critically comparing individual immobilisation with immobility syndrome, especially through the application of the Authors' own substantial hands-on therapeutic experience in managing various rehabilitation schemes, specifically aided by diverse virtual reality technology solutions.
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Affiliation(s)
- Marek Zak
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland;
| | - Magdalena Wasik
- Doctoral School, Collegium Medicum, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland; (M.W.); (T.S.)
| | - Tomasz Sikorski
- Doctoral School, Collegium Medicum, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland; (M.W.); (T.S.)
| | - Krzysztof Aleksandrowicz
- Department of Physiotherapy, Faculty of Health Sciences, Wroclaw Medical University, T. Chałubińskiego 3, 50-368 Wroclaw, Poland;
- Institute of Heart Diseases, University Hospital, Borowska 213, 50-556 Wroclaw, Poland
| | - Renata Miszczuk
- Institute of Pedagogy, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland;
| | - Daniel Courteix
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Université Clermont Auvergne, 63000 Clermont-Ferrand, France;
| | - Frederic Dutheil
- Occupational and Environmental Medicine, CHU, 63000 Clermont-Ferrand, France;
- Physiological and Psychosocial Stress, Université Clermont Auvergne, CNRS, LaPSCo, 63000 Clermont-Ferrand, France
| | - Aneta Januszko-Szakiel
- Institute of Information Studies, Faculty of Managment and Social Communication, Jagiellonian University, ul. Lojasiewicza 4, 30-348 Krakow, Poland;
| | - Waldemar Brola
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland;
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12
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Baek S, Park JH. Negative Pressure Wound Therapy (NPWT) after Hybrid Reconstruction of Occipital Pressure Sore Using Local Flap and Skin Graft. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1342. [PMID: 37512153 PMCID: PMC10386472 DOI: 10.3390/medicina59071342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
Background and objectives: Pressure sores are a common medical burden among patients, particularly those who are bedridden or frail. Surgical management of occipital pressure sores poses unique challenges due to limited elasticity and the spherical shape of the scalp. This study aims to evaluate the efficacy and safety of a novel reconstruction method utilizing a local transpositional flap and split-thickness skin graft with negative pressure wound therapy (NPWT) for occipital pressure sore treatment. Material and methods: A retrospective analysis was performed on patients with occipital pressure sores who underwent hybrid reconstructions using a local flap and split-thickness skin graft in conjunction with NPWT. Surgical outcomes, including flap survival rate, graft take percentage, and complications, were assessed. A comparative analysis was performed between the NPWT group and the conventional dressing group. Results: The NPWT group (n = 24) demonstrated a significantly higher mean graft take percentage at postoperative day 14 compared with the conventional dressing group (n = 22) (98.2% vs. 81.2%, p < 0.05). No significant difference in flap survival rate was observed between the two groups. Conclusions: As the aging population continues to grow, occipital pressure sores have gained significant attention as a crucial medical condition. The innovative surgical method incorporating NPWT offers an efficient and safe treatment option for patients with occipital pressure sores, potentially establishing itself as the future gold standard for managing this condition.
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Affiliation(s)
- Seungchul Baek
- Department of Plastic and Reconstructive Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea
| | - Jun Ho Park
- Department of Plastic and Reconstructive Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea
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13
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Baker R, Klim S, Poonian J, Ritchie P, Ng S, Kelly AM. SOFTLY: Comparison of outcomes of rigid versus soft collar during emergency department investigation for potential cervical spine injury in low-risk blunt trauma patients - A pilot study. Emerg Med Australas 2023. [PMID: 36914237 DOI: 10.1111/1742-6723.14195] [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: 01/23/2023] [Revised: 01/29/2023] [Accepted: 02/20/2023] [Indexed: 03/15/2023]
Abstract
OBJECTIVE Blunt trauma patients with potential cervical spine injury are traditionally immobilised in rigid collars. Recently, this has been challenged. The present study's objective was comparison of the rate of patient-oriented adverse events in stable, alert, low-risk patients with potential cervical spine injuries immobilised in rigid versus soft collars. METHODS Unblinded, prospective quasi-randomised clinical trial of neurologically intact, adult, blunt trauma patients assessed as having potential cervical spine injury. Patients were randomised to collar type. All other aspects of care were unchanged. Primary outcome was patient-reported discomfort related to neck immobilisation by collar type. Secondary outcomes included adverse neurological events, agitation and clinically important cervical spine injuries (clinical trial registration number: ACTRN12621000286842). RESULTS A total of 137 patients were enrolled: 59 patients allocated to a rigid collar and 78 to a soft collar. Most injuries were from a fall <1 m (54%) or a motor vehicle crash (21.9%). Median neck pain score of collar immobilisation was lower in the soft collar group (3.0 [interquartile range 0-6.1] vs 6.0 [interquartile range 3-8.8], P < 0.001). The proportion of patients with clinician-identified agitation was lower in the soft collar group (5% vs 17%, P = 0.04). There were four clinically important cervical spine injuries (two in each group). All were treated conservatively. There were no adverse neurological events. CONCLUSIONS Use of soft rather than rigid collar immobilisation for low-risk blunt trauma patients with potential cervical spine injury is significantly less painful for patients and results in less agitation. A larger study is needed to determine the safety of this approach or whether collars are required at all.
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Affiliation(s)
- Robert Baker
- Emergency Department, Western Health, Melbourne, Victoria, Australia
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia
| | - Jasmine Poonian
- Emergency Department, Western Health, Melbourne, Victoria, Australia
| | - Peter Ritchie
- Emergency Department, Western Health, Melbourne, Victoria, Australia
| | - Stephanie Ng
- Emergency Department, Western Health, Melbourne, Victoria, Australia
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
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14
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Sardo PMG, Teixeira JPF, Machado AMSF, Oliveira BF, Alves IM. A systematic review of prevalence and incidence of pressure ulcers/injuries in hospital emergency services. J Tissue Viability 2023; 32:179-187. [PMID: 36792441 DOI: 10.1016/j.jtv.2023.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 01/21/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023]
Abstract
AIM To develop a systematic review on the prevalence and the incidence of pressure ulcers/injuries in adult patients in hospital emergency services. MATERIALS AND METHODS Systematic review of prevalence and incidence studies developed according to the Preferred Reporting Items Form Systematic Review and Meta-Analysis Protocols and the Joanna Briggs Institute methodology. The inclusion criteria were based on the CoCoPop mnemonic. The main variables of interest were the "prevalence" and/or the "incidence" of "pressure ulcers/injuries" (Condition) reported in studies developed in hospital emergency services (Context) with adult participants (Population). The Systematic Review Protocol was registered in PROSPERO (CDR42021252906). RESULTS The pressure ulcer/injury (point) prevalence ranged from 5.2% (at admission) to 12.3% (at discharge) and the pressure ulcer/injury incidence ranged from 4.5% to 78.4%. Most of the pressure ulcers/injuries documented were category/stage I. The most problematic anatomical locations were the sacrococcygeal region and the heels. The preventive measures should be implemented as soon as possible and are important in patients older than 75 years, with multiple comorbidities, high C-Reative Protein levels, cervical spine immobilization, presented to hospital emergency service by ambulance or with hypotension at the time of admission. CONCLUSIONS The prevalence and incidence of pressure ulcers/injuries in hospital emergency services remains an understudied topic which could limit the generalization of our data. This systematic review highlighted that the management of pressure ulcers/injuries is a real and current challenge in hospital emergency services. It is important to identify the patients at (higher) risk to establish an (earlier) preventive care plan according to patients and emergency services' characteristics.
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Affiliation(s)
- Pedro Miguel Garcez Sardo
- School of Health Sciences, University of Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Portugal.
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15
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Practice patterns after implementation of a selective spinal immobilization protocol in a regional trauma system. J Trauma Acute Care Surg 2022; 93:806-812. [PMID: 35234714 DOI: 10.1097/ta.0000000000003589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Universal spinal immobilization has been the standard of prehospital trauma care since the 1960s. Selective immobilization has been shown to be safe and effective for emergency medical services use, but it is unclear whether such protocols reduce unnecessary and potentially harmful immobilization practices. This study evaluated the impact of a selective spinal immobilization protocol on practice patterns in a regional trauma system. METHODS All encounters for traumatic injury in the Tidewater Emergency Medical Services region from 2010 to 2016 were extracted from the Virginia Pre-Hospital Information Bridge. An interrupted time series analysis was used to assess practice change after system-wide protocol implementation in 2013. Intravenous access was used as a nonequivalent outcome measure in the absence of an appropriate control group. RESULTS A total of 63,981 encounters were analyzed. At baseline, 16.7% of patients underwent full immobilization. The preprotocol slope was slightly positive (0.2% per month; 95% confidence interval, 0.1-0.2%). Slope and level changes after protocol implementation did not differ from those observed for intravenous access (-0.4% vs. -0.4% per month [ p = 0.4917] and -1.6% vs. -1.1% [ p = 0.1202], respectively). Cervical spinal immobilization became more common over the postimplementation period (0.1% per month; 95% confidence interval, 0.1-0.1%). Rates of immobilization for isolated penetrating trauma remained unchanged. CONCLUSION Implementation of a selective spinal immobilization protocol did not reduce prehospital immobilization rates in a regional trauma system. Given the entrenched nature of immobilization practices, more intensive education and training strategies are needed. Efforts should prioritize eliminating immobilization for isolated penetrating trauma given its association with increased mortality. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
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16
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Raisch P, Jung MK, Vetter SY, Grützner PA, Kreinest M. Post-operative Use of Cervical Orthoses for Subaxial Cervical Spine Injuries - a Survey-based Analysis at German Spine Care Centres. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:637-645. [PMID: 34496425 DOI: 10.1055/a-1522-9129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There are no evidence-based recommendations for the post-operative treatment and application of soft or rigid cervical collars after operative treatment of injuries of the subaxial cervical spine. Cervical collars can restrict peak range of motion and serve as a reminder to the patient. However, they can also cause pressure ulcers. The aim of this online-based survey among German spine centres was to gain an overview of post-operative treatment and the application of soft or rigid cervical collars after surgical treatment of injuries of the subaxial cervical spine. MATERIALS AND METHODS An online-based survey was conducted among 59 spine centres certified by the German Spine Society. It comprised seven items and the option of adding remarks in the form of open-ended responses. RESULTS The return rate was 63% (37 out of 59). Of the 37 analysed spine centres, 51% routinely apply a cervical collar post-operatively, 27% apply a soft and 16% a rigid cervical collar, 8% sequentially apply first a rigid and later a soft cervical collar. Less than half of the spine centres (43%) routinely use no cervical collar. Rigid collars are applied for more than 6 weeks and soft collars up to 6 weeks at some spine centres. Standardised post-operative treatment plans are common. The selection of the post-operative treatment plan depends primarily on the type of injury and method of operation and partly on patient age and bone quality. The satisfaction of German spine centres with the current handling of post-operative treatment of subaxial cervical spine injuries is high. DISCUSSION The post-operative treatment of injuries of the subaxial cervical spine at German spine centres is heterogeneous, and the evidence on advantages and disadvantages of the post-operative application of cervical collars is insufficient. Planning and implementation of randomised controlled clinical trials in subaxial cervical spine injuries is challenging.
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Affiliation(s)
- Philipp Raisch
- Clinic for Trauma Surgery and Orthopaedics, BG Trauma Center Ludwigshafen, Germany
| | - Matthias K Jung
- Clinic for Trauma Surgery and Orthopaedics, BG Trauma Center Ludwigshafen, Germany
| | - Sven Y Vetter
- Clinic for Trauma Surgery and Orthopaedics, BG Trauma Center Ludwigshafen, Germany
| | - Paul A Grützner
- Clinic for Trauma Surgery and Orthopaedics, BG Trauma Center Ludwigshafen, Germany
| | - Michael Kreinest
- Clinic for Trauma Surgery and Orthopaedics, BG Trauma Center Ludwigshafen, Germany
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17
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Mota M, Cunha M, Santos E, Abrantes T, Melo F, Monteiro M, Santos MR. Prehospital interventions to reduce discomfort caused by immobilization in adult trauma victims: a scoping review protocol. JBI Evid Synth 2022; 20:2743-2750. [PMID: 36081390 DOI: 10.11124/jbies-22-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this review is to identify the level of discomfort caused by immobilization as reported by trauma victims, and to map all the interventions in the prehospital context where they have been implemented and evaluated in order to reduce discomfort in adult victims of trauma. INTRODUCTION Immobilization is a cause of discomfort for trauma victims, which has important implications for the deterioration of vital signs and quality of life. However, discomfort caused by immobilization remains an under-explored topic by the scientific community. INCLUSION CRITERIA This scoping review will consider studies of adult victims of trauma, aged 18 years or over, in prehospital emergency care. Studies that focus on interventions designed to reduce immobilization discomfort, implemented and evaluated by health professionals, of any form, duration, frequency, and dose will be considered. METHODS An initial search of PubMed and CINAHL will be undertaken, followed by a second search for published and unpublished studies without time restrictions, in major health care-related electronic databases. Studies in English, French, Spanish, and Portuguese will be included. Data extraction will be performed independently by 2 reviewers in a tabular format and will include details about the level of discomfort, interventions, populations, study methods, and outcomes of interest. A narrative synthesis will accompany the results and will describe how they relate to the review objectives. REVIEW REGISTRATION NUMBER OSF https://osf.io/4scg5/.
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Affiliation(s)
- Mauro Mota
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.,Health School of the Polytechnic Institute of Viseu, Viseu, Portugal.,Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal.,Local Health Unit of Guarda, Guarda, Portugal.,INEM - National Institute of Medical Emergency, Lisboa, Portugal
| | - Madalena Cunha
- Health School of the Polytechnic Institute of Viseu, Viseu, Portugal.,Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Eduardo Santos
- Health School of the Polytechnic Institute of Viseu, Viseu, Portugal.,Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal.,Portugal Centre for Evidence-Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, Coimbra, Portugal
| | - Tito Abrantes
- Hospital São Teotónio, Tondela Viseu Hospital Centre, Viseu, Portugal
| | - Filipe Melo
- INEM - National Institute of Medical Emergency, Lisboa, Portugal.,Algarve Biomedical Center, Faro, Portugal.,Algarve Hospital and Universitary Centre, Faro, Portugal
| | | | - Margarida Reis Santos
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.,Nursing School of Porto, Porto, Portugal.,Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
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18
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Grenier G, Despatis MA, Lebel K, Hamel M, Martin C, Boissy P. Removal of the cervical collar from alpine rescue protocols? A biomechanical non-inferiority trial in real-life mountain conditions. Scand J Trauma Resusc Emerg Med 2022; 30:42. [PMID: 35761355 PMCID: PMC9235139 DOI: 10.1186/s13049-022-01031-3] [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: 12/02/2021] [Accepted: 06/20/2022] [Indexed: 11/15/2022] Open
Abstract
Background Alpine skiing rescues are challenging because of the mountainous environment and risks of cervical spine motion (CSM) induced during victims’ extrications (EXs) and downhill evacuations (DEs). The benefits of applying a cervical collar (CC) over manual in-line stabilization without CC (MILS) in terms of spinal motion restriction during simulated alpine rescues are undocumented. Our hypothesis was that CSM recorded using MILS alone is non-inferior to CSM recorded with a CC according to a 10 degrees margin.
Methods A total of 32 alpine extrications and 4 downhill evacuations on different slope conditions were performed using a high fidelity mannequin designed with a motion sensors instrumented cervical spine. The primary outcome was the peak extrication 3D excursion angle (Peak 3D θEX,) of the mannequin’s head. The secondary objectives were to describe the time to extrication completion (tEX) and to highlight which extrication manipulation is more likely to induce CSM. Results The median Peak 3D θEX recorded during flat terrain extrications using CC was 10.77° (95% CI 7.31°–16.45°) compared to 13.06° (95% CI 10.20°–30.36°) using MILS, and 16.09° (95% CI 9.07°–37.43°) for CC versus 16.65° (95% CI 13.80°–23.40°) using MILS on a steep slope. Peak 3D θEX with CC or using MILS during extrications were equivalent according to a 10 degrees non-inferiority hypothesis testing (p < 0.05). Time to extrication completion (tEX) was significantly reduced using MILS without CC on a flat terrain with a median duration of 237,3 s (95% CI 197.8 s, 272.2 s) compared to 358.7 s (95% CI 324.1 s, 472.4 s). During downhill evacuations, CSM with and without CC across all terrain conditions were negligible (< 5°). When CC is used; its installation manipulation induces the highest CSM. When EXs are done using MILS without CC, the logroll initiation is the manipulation inducing the highest risk of CSM. Conclusion For experienced ski patrollers, the biomechanical benefits of spinal motion restriction provided by CC over MILS during alpine skiing rescues appear to be marginal and CC use negatively affects rescue time. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-022-01031-3.
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Affiliation(s)
- Guillaume Grenier
- Faculty of Medicine and Health Sciences, Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Marc-Antoine Despatis
- Faculty of Medicine and Health Sciences, Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Karina Lebel
- Faculty of Engineering, Department of Electrical and Computing Engineering, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Center on Aging, CIUSSS Estrie CHUS, Sherbrooke, QC, Canada
| | - Mathieu Hamel
- Research Center on Aging, CIUSSS Estrie CHUS, Sherbrooke, QC, Canada
| | - Camille Martin
- Faculty of Engineering, Department of Electrical and Computing Engineering, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Center on Aging, CIUSSS Estrie CHUS, Sherbrooke, QC, Canada
| | - Patrick Boissy
- Faculty of Medicine and Health Sciences, Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada. .,Research Center on Aging, CIUSSS Estrie CHUS, Sherbrooke, QC, Canada.
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19
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Vk V, Bhoi S, Aggarwal P, Murmu LR, Agrawal D, Kumar A, Sinha TP, Galwankar S. Diagnostic utility of point of care ultrasound in identifying cervical spine injury in emergency settings. Australas J Ultrasound Med 2021; 24:208-216. [PMID: 34888130 DOI: 10.1002/ajum.12274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 05/13/2021] [Accepted: 05/19/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction The evaluation of cervical-spine in a major trauma patient needs a bedside efficient tool to rule out cervical spine injury as the role of X-ray and Computed Tomography (CT) in this setting is limited. Point of care ultrasonography (POCUS) is being used as an adjunct during trauma resuscitation. The aim of this study was to evaluate the use of POCUS for identifying cervical spine injuries. Methods We recruited 84 cases with cervical spine injury based on CT scan after taking consent. POCUS was used as per the operational definition of study methods while maintaining manual in-line stabilisation. Statistical analysis was done by using STATA version 14. Results Normal cervical anatomy was visible through anterior approach in POCUS except for the 1st and 2nd cervical vertebrae. The sensitivity and specificity of POCUS vs CT scan for vertebral body listhesis were 84.52% (95% CI of 0.65-0.95) and 89.66% (95% CI 0.78-0.96) with p-value <0.0001. Sensitivity and specificity of POCUS vs CT for vertebral body fracture were 40.91% (95% CI of 0.20-0.63) and 96.77% (95% CI of 0.88-0.99) with p-value <0.0001. The overall sensitivity and specificity of POCUS were 45.83% and 83.33% (p = 0.06) and excluding isolated posterior column injuries, sensitivity and specificity were 70.21% and 83.33% (p < 0.05). Conclusion POCUS identified injuries such as fracture and listhesis. Because of high rate of missed injuries, ultrasound at present cannot be used as a screening or diagnostic tool for decision-making in cervical spine injury.
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Affiliation(s)
- Vishnu Vk
- Department of Emergency Medicine All India Institute of Medical Sciences (AIIMS) New Delhi India
| | - Sanjeev Bhoi
- Department of Emergency Medicine JPN Apex Trauma Centre AIIMS New Delhi India
| | - Praveen Aggarwal
- Department of Emergency Medicine All India Institute of Medical Sciences (AIIMS) New Delhi India
| | - L R Murmu
- Department of Emergency Medicine All India Institute of Medical Sciences (AIIMS) New Delhi India
| | - Deepak Agrawal
- Department of Neurosurgery JPN Apex Trauma Centre AIIMS New Delhi India
| | - Atin Kumar
- Department of Radiodiagnosis JPN Apex Trauma Centre AIIMS New Delhi India
| | - Tej Prakash Sinha
- Department of Emergency Medicine All India Institute of Medical Sciences (AIIMS) New Delhi India
| | - Sagar Galwankar
- Department of Emergency Medicine Florida State University Sarasota USA
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20
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Jung MK, von Ehrlich-Treuenstätt GVR, Jung AL, Keil H, Grützner PA, Schneider NRE, Kreinest M. Evaluation of external stabilization of type II odontoid fractures in geriatric patients-An experimental study on a newly developed cadaveric trauma model. PLoS One 2021; 16:e0260414. [PMID: 34843595 PMCID: PMC8629171 DOI: 10.1371/journal.pone.0260414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/09/2021] [Indexed: 12/29/2022] Open
Abstract
Background Along with the growing geriatric population, the number of odontoid fractures is steadily increasing. However, the effectiveness of immobilizing geriatric odontoid fractures using a cervical collar has been questioned. The aim of the present study is to analyze the physiological and pathological motion in odontoid fractures and to assess limitation of motion in the cervical spine when applying a cervical collar. Methods Motion analysis was performed with wireless motion tracker on unfixed geriatric human cadavers. First, a new geriatric type II odontoid fracture model was developed. In this model, the type II odontoid fracture is operated via a transoral approach. The physiological and pathological flexion and lateral bending of the cervical spine resulting from this procedure was measured. The resulting motion after external stabilization using a cervical collar was analyzed. Results The new geriatric type II odontoid fracture model was successfully established using seven unfixed human cadavers. The pathological flexion of the cervical spine was significantly increased compared to the physiological flexion (p = 0.027). Furthermore, the flexion was significantly reduced when a cervical collar was applied. In case of flexion the mean remaining motion was significantly reduced (p = 0.0017) from 41° to 14°. For lateral bending the mean remaining motion was significantly reduced (p = 0.0137) from 48° to 18°. Conclusions In case of type II odontoid fracture, flexion and lateral bending of the cervical spine are increased due to spinal instability. Thus, if an odontoid fracture is suspected in geriatric patients, the application of a cervical collar should always be considered since external stabilization can significantly reduce flexion and lateral bending.
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Affiliation(s)
- Matthias K. Jung
- BG Trauma Center Ludwigshafen, Clinic for Trauma and Orthopaedic Surgery, University of Heidelberg, Ludwigshafen on the Rhine, Germany
| | | | - Andreas L. Jung
- BG Trauma Center Ludwigshafen, Clinic for Trauma and Orthopaedic Surgery, University of Heidelberg, Ludwigshafen on the Rhine, Germany
| | - Holger Keil
- Clinic for Trauma and Orthopaedic Surgery, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Paul A. Grützner
- BG Trauma Center Ludwigshafen, Clinic for Trauma and Orthopaedic Surgery, University of Heidelberg, Ludwigshafen on the Rhine, Germany
| | | | - Michael Kreinest
- BG Trauma Center Ludwigshafen, Clinic for Trauma and Orthopaedic Surgery, University of Heidelberg, Ludwigshafen on the Rhine, Germany
- * E-mail:
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21
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Nwachuku E, Njoku-Austin C, Patel KP, Anthony AW, Mittal A, Hamilton DK, Kanter A, Gerszten PC, Okonkwo D. Isolated traumatic occipital condyle fractures: Is external cervical orthosis even necessary? Surg Neurol Int 2021; 12:524. [PMID: 34754574 PMCID: PMC8571366 DOI: 10.25259/sni_748_2021] [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: 07/30/2021] [Accepted: 08/26/2021] [Indexed: 11/11/2022] Open
Abstract
Background: Occipital condyle fractures (OCFs) have been reported in up to 4–16% of individuals suffering cervical spine trauma. The current management of OCF fractures relies on a rigid cervical collar for 6 weeks or longer. Here, we calculated the rate of acute and delayed surgical intervention (occipitocervical fusion) for patients with isolated OCF who were managed with a cervical collar over a 10-year period at a single institution. Methods: This was a retrospective analysis performed on all patients admitted to a Level 1 Trauma Center between 2008 and 2018 who suffered traumatic isolated OCF managed with an external rigid cervical orthosis. Radiographic imaging was reviewed by several board-certified neuroradiologists. Demographic and clinical data were collected including need for occipitocervical fusion within 12 months after trauma. Results: The incidence of isolated OCF was 4% (60/1536) for those patients admitted with cervical spine fractures. They averaged 49 years of age, and 58% were male falls accounted for the mechanism of injury in 47% of patients. Classification of OCF was most commonly classified in 47% as type I Anderson and Montesano fractures. Of the 60 patients who suffered isolated OCF that was managed with external cervical orthosis, 0% required occipitocervical fusion within 12 months posttrauma. About 90% were discharged, while the remaining 10% sustained traumatic brain/orthopedic injury that limited an accurate neurological assessment. Conclusion: Here, we documented a 4% incidence of isolated OCF in our cervical trauma population, a rate which is comparable to that found in the literature year. Most notably, we documented a 0% incidence for requiring delayed occipital-cervical fusions.
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Affiliation(s)
- Enyinna Nwachuku
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Confidence Njoku-Austin
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Kevin P Patel
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Austin W Anthony
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Aditya Mittal
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - David Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Adam Kanter
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Peter C Gerszten
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - David Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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22
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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] [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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Araghi K, Jacofsky M, McCamley J. Comparison of cervical motion restriction and interface pressure between two cervical collars. Clin Biomech (Bristol, Avon) 2021; 89:105482. [PMID: 34537462 DOI: 10.1016/j.clinbiomech.2021.105482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/04/2021] [Accepted: 09/07/2021] [Indexed: 02/07/2023]
Abstract
Background Cervical collar treatment is widespread amongst a broad range of ages and conditions. However, these devices are associated with a known correlation between collar usage and adverse effects such as pressure ulcers, infections, exacerbated spinal injury, and higher morbidity. The objective of this study was to determine if the ability of a newly developed DJO Procare XTEND 174 collar to restrict cervical spine motion was similar to that of the previously studied Össur Miami J collar and to determine if this was done while producing similar tissue interface pressures. Methods Three-dimensional kinematic data were obtained for twelve healthy volunteer participants (6 female, 6 male) using a 10-camera infrared motion capture system. Cervical range of motion in each plane was calculated using angles between head and thorax rigid-body axes. Tissue interface pressure was measured between the head and the collar with three flexible pressure sensor pads over the anterior mandibles and occiput. The distribution of interface pressures was obtained in both the seated and supine positions. Findings Both collars significantly restricted range of motion in all movement directions (p < 0.001) compared to no collar. There were no significant differences in restrictiveness nor in tissue interface pressures between the collars. Both collars exhibited similar range of motion restriction and similar interface pressures. Interpretation Our data indicate that the newly developed Procare XTEND 174 collar is not statistically different from the scientifically recognized Miami J benchmark collar regarding cervical range of motion restriction in all three planes and tissue interface pressure.
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Affiliation(s)
- Kasra Araghi
- MORE Foundation, 18444 N 25(th) Ave. Suite 110, Phoenix, AZ 85023, USA.
| | - Marc Jacofsky
- MORE Foundation, 18444 N 25(th) Ave. Suite 110, Phoenix, AZ 85023, USA; The CORE Institute, 18444 N 25(th) Ave. Suite 320, Phoenix, AZ 85023, USA.
| | - John McCamley
- MORE Foundation, 18444 N 25(th) Ave. Suite 110, Phoenix, AZ 85023, USA.
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Jung MK, Hörnig L, Stübs MMA, Grützner PA, Kreinest M. Analysis of diagnostics, therapy and outcome of patients with traumatic atlanto-occipital dislocation. Spine J 2021; 21:1513-1519. [PMID: 33757869 DOI: 10.1016/j.spinee.2021.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patients' outcome following traumatic atlanto-occipital dislocation (AOD) has been poor. In recent years, an increasing number of patients surviving the initial trauma are admitted to hospital. In order to further improve the management of these patients, the knowledge of diagnostics and therapy as well as possible complications should be increased. PURRPOSE The aim of this study was to evaluate diagnostic parameters, therapy, early complications and outcome of patients with traumatic AOD. STUDY DESIGN Monocentric retrospective cohort study. PATIENT SAMPLE A total of 12 patients were included in this study. OUTCOME MEASURES The main outcome measure was functional patient outcome. Furthermore, radiographic and treatment data were analyzed. METHODS All patients suffering from traumatic AOD within an 8-year time period were included. Demographic data, radiological diagnostic parameters (condylar sum, basion dens interval, basion axis interval, power´s ratio, x-line method), as well as treatment data and complications of every patient were analyzed. Radiological parameters were compared with each other. Outcome was analyzed by a follow up examination. RESULTS The accident mechanisms were motor vehicle accidents (MVA), fall from high and low height. Basion dens interval, basion axis interval, power's ratio and x-line method were not reliable in identifying traumatic AOD (only up to 33% of the patients were identified). Twelve patients could be reviewed. Three patients were treated with surgery, five patients were treated nonsurgically. Four patients died before surgical therapy. All seven surviving patients (survival rate: 58.3%) were re-examined (mean follow-up time: 6.7 months). All patients had a GCS of 15. Three surviving patients suffered from persisting neurological deficits. CONCLUSIONS The most reliable way to diagnose AOD in Computer Topography is using the condylar sum. Surgical and nonsurgical measures can be employed with reasonable outcomes. Patient specific injury burden and clinical presentation should be taken into account when making treatment decisions for AOD.
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Affiliation(s)
- Matthias K Jung
- BG Trauma Center Ludwigshafen, University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen on the Rhine, Germany
| | - Lukas Hörnig
- BG Trauma Center Ludwigshafen, University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen on the Rhine, Germany
| | - Michael M A Stübs
- Department of Anesthesiology, Stiftung Krankenhaus Bethanien, Bethanienstraße 21, 47441 Moers, Germany
| | - Paul A Grützner
- BG Trauma Center Ludwigshafen, University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen on the Rhine, Germany
| | - Michael Kreinest
- BG Trauma Center Ludwigshafen, University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen on the Rhine, Germany.
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Getu S, Tiruneh T, Andualem H, Hailemichael W, Kiros T, Mesfin Belay D, Kiros M. Coagulopathy in SARS-CoV-2 Infected Patients: Implication for the Management of COVID-19. J Blood Med 2021; 12:635-643. [PMID: 34305416 PMCID: PMC8296964 DOI: 10.2147/jbm.s304783] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/16/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 disease has led to an extraordinary inclusive health crisis globally. Elevation of D-dimer is the major remarkable abnormal coagulation test in seriously ill COVID-19 patients. In nearly 50% of COVID-19 patients, the value of D-dimer was significantly enhancing. Recent literature indicated that COVID-19 patients were at higher risk of developing disseminated intravascular coagulation. Pro-inflammatory cytokines and chemokines are some of the factors leading to these conditions. The majority of COVID-19 patients showed a higher profile of pro-inflammatory cytokines and chemokines in severe clinical conditions. Tumor necrosis factor-α (TNF-α) and interleukins (ILs) elevated in COVID-19 infected patients. TNF-α, IL-6, and IL-1 are major cytokines vital for the inhibition of intrinsic anticoagulant pathways. COVID-19 becomes a higher complication with a significant effect on blood cell production and hemostasis cascades. Deep vein thrombosis and arterial thrombosis are common complications. Changes in hematological parameters are also frequently observed in COVID-19 patients. Especially, thrombocytopenia is an indicator for poor prognosis of the disease and is highly expected and aggravates the likelihood of death of SARS-CoV-2 infected individuals. Thrombopoiesis reduction in COVID-19 patients might be due to viral abuse of the bone marrow/the viral load may affect thrombopoietin production and function. In other ways, immune-inflammation-mediated destruction and increased consumption of platelets are also the possible proposed mechanisms for thrombocytopenia. Therefore, the counting of platelet cells is an easily accessible biomarker for disease monitoring. All SARS-CoV-2 infected patients should be admitted and identifying potential higher-risk patients. It is also obligatory to provide appropriate treatments with intensive care and strict follow-up. In addition, considerations of chronic diseases are essential for better prognosis and recovery. The current review discusses coagulopathy among SARS-CoV-2 infected individuals and its complication for the management of the disease.
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Affiliation(s)
- Sisay Getu
- Hematology and Immuno-hematology, Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tegenaw Tiruneh
- Hematology and Immuno-hematology, Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Henok Andualem
- Immunology and Molecular Biology, Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wasihun Hailemichael
- Immunology and Molecular Biology, Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Teklehayimanot Kiros
- Microbiology, Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demeke Mesfin Belay
- Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulugeta Kiros
- Microbiology, Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Harris L, Arif S, Elliot M, Brady Z, Lawrence A, Lee C, Tsang K. Fusion rates for conservative and surgical management of type II odontoid fractures and its impact. Br J Neurosurg 2021; 35:607-610. [PMID: 33998359 DOI: 10.1080/02688697.2021.1926921] [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
BACKGROUND Type II odontoid fractures are known to have low fusion rates following conservative management with a hard collar. However, most patients are elderly with comorbidities and are not fit for surgery. The present study identified the rates of bony fusion, complications, and clinical outcomes following conservative management of type II odontoid fractures. METHODS We included consecutive patients referred with a suspected odontoid fracture to a Major Trauma Centre in the UK between March 2015 and December 2017. Data including patient demographics, fracture management, complications and outcomes. Bony fusion was assessed by two neurosurgeons and one neuroradiologists. Results were analysed with simple statistics and chi-squared test. RESULTS 102 patients were included in the study (mean age = 80.4 ± 15.3). 10 (9.8%) were managed surgically and 92 (90.2%) were managed conservatively with a hard collar, for a mean of 87 days. Patients were followed up for a mean of 28.1 months (range 1-855 days) until discharge. 37% developed collar complications, namely pain, stiffness and non-tolerance. Bony union was achieved in 37.3% of patients treated with a hard collar (versus 80% in the surgical group, p = 0.0096). Increasing age was an independent risk factor for non-union (p < 0.001). Of the patients without bony union, none reported symptoms, and 90% were discharged without a collar. CONCLUSION The management of type II odontoid fractures are difficult in an elderly, co-morbid population. With conservative management fusion rates are low, and collar complications are not insignificant. However, outcomes are good regardless of union.
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Affiliation(s)
- Lauren Harris
- Division of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK
| | | | - Matthew Elliot
- Division of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK
| | | | - Alistair Lawrence
- Division of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK
| | - Cheong Lee
- Division of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK
| | - Kevin Tsang
- Division of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK
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[The position of the head during treatment in the emergency room-an explorative analysis of immobilization of the cervical spine]. Anaesthesist 2021; 70:922-927. [PMID: 33909105 DOI: 10.1007/s00101-021-00965-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/23/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Immobilization of the cervical spine is a standard procedure in emergency medicine mostly achieved via a cervical collar. In the emergency room other forms of immobilization are utilized as cervical collars have certain drawbacks. The present study aimed to provide preliminary data on the efficiency of immobilization in the emergency room by analyzing the residual spinal motion of the patient's head on different kinds of head rests. METHODS In the present study biomechanical motion data of the cervical spine of a test subject were analyzed. The test subject was placed in a supine position on a mobile stretcher (Stryker M1 Roll-In System, Kalamazoo, MI, USA) wearing a cervical collar (Perfit ACE, Ballerup, Denmark). Three different head rests were tested: standard pillow, concave pillow and cavity pillow. The test subject carried out a predetermined motion protocol: right side inclination, left side inclination, flexion and extension. The residual spinal motion was recorded with wireless motion trackers (inertial measurement unit, Xsens Technologies, Enschede, The Netherlands). The first measurement was performed without a cervical collar or positioning on the pillows to measure the physiological baseline motion. Subsequently, three measurements were taken with the cervical collar applied and the pillows in place. From these measurements, a motion score was calculated that can represent the motion of the cervical spine. RESULTS When the test subject's head was positioned on a standard pillow the physiological motion score was reduced from 69 to 40. When the test subject's head was placed on concave pillow the motion score was further reduced from 69 to 35. When the test subject's head was placed on cavity pillow the motion score was reduced from 69 to 59. The observed differences in the overall motion score of the cervical spine are mainly due to reduced flexion and extension rather than rotation or lateral inclination. CONCLUSION The motion score of the cervical spine using motion sensors can provide important information for future analyses. The results of the present study suggest that trauma patients can be immobilized in the early trauma phase with a cervical collar and a head rest. The application of a cervical collar and the positioning on the concave pillow may achieve a good immobilization of the cervical spine in trauma patients in the early trauma phase.
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Ms R, Riffelmann M, Kunze-Szikszay N, Lier M, Schmid O, Haus H, Schneider S, Jf H. Vacuum mattress or long spine board: which method of spinal stabilisation in trauma patients is more time consuming? A simulation study. Scand J Trauma Resusc Emerg Med 2021; 29:46. [PMID: 33706791 PMCID: PMC7953765 DOI: 10.1186/s13049-021-00854-w] [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: 08/23/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spinal stabilisation is recommended for prehospital trauma treatment. In Germany, vacuum mattresses are traditionally used for spinal stabilisation, whereas in anglo-american countries, long spine boards are preferred. While it is recommended that the on-scene time is as short as possible, even less than 10 minutes for unstable patients, spinal stabilisation is a time-consuming procedure. For this reason, the time needed for spinal stabilisation may prevent the on-scene time from being brief. The aim of this simulation study was to compare the time required for spinal stabilisation between a scoop stretcher in conjunction with a vacuum mattress and a long spine board. METHODS Medical personnel of different professions were asked to perform spinal immobilizations with both methods. A total of 172 volunteers were immobilized under ideal conditions as well as under realistic conditions. A vacuum mattress was used for 78 spinal stabilisations, and a long spinal board was used for 94. The duration of the procedures were measured by video analysis. RESULTS Under ideal conditions, spinal stabilisation on a vacuum mattress and a spine board required 254.4 s (95 % CI 235.6-273.2 s) and 83.4 s (95 % CI 77.5-89.3 s), respectively (p < 0.01). Under realistic conditions, the vacuum mattress and spine board required 358.3 s (95 % CI 316.0-400.6 s) and 112.6 s (95 % CI 102.6-122.6 s), respectively (p < 0.01). CONCLUSIONS Spinal stabilisation for trauma patients is significantly more time consuming on a vacuum mattress than on a long spine board. Considering that the prehospital time of EMS should not exceed 60 minutes and the on-scene time should not exceed 30 minutes or even 10 minutes if the patient is in extremis, based on our results, spinal stabilisation on a vacuum mattress may consume more than 20 % of the recommended on-scene time. In contrast, stabilisation on a spine board requires only one third of the time required for that on a vacuum mattress. We conclude that a long spine board may be feasible for spinal stabilisation for critical trauma patients with timesensitive life threatening ABCDE-problems to ensure the shortest possible on-scene time for prehospital trauma treatment, not least if a patient has to be rescued from an open or inaccessible terrain, especially that with uneven overgrown land.
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Affiliation(s)
- Roessler Ms
- Department for Anaesthesiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
| | - M Riffelmann
- Praxis Schmallenberg, Obringhauser Strasse 4, 57392, Schmallenberg, Germany
| | - N Kunze-Szikszay
- Department for Anaesthesiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - M Lier
- Department for Anaesthesiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - O Schmid
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Eichsfeld Clinic, Windische Gasse 112, 37308, Heilbad Heiligenstadt, Germany
| | - H Haus
- Department for Anaesthesiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - S Schneider
- Department of Medical Statistics, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - Heuer Jf
- Department of Anaesthesiology, Intensive-Care-, Emergency- and Pain-Medicine, Augusta Krankenanstalt Bochum, Bergstrasse 26, 44791, Bochum, Germany
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Geldenhuys MJ, Downing C. Evidence-Based Nursing Care for Spinal Nursing Immobilization: A Systematic Review. J Emerg Nurs 2021; 46:318-337. [PMID: 32389205 DOI: 10.1016/j.jen.2020.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/08/2020] [Accepted: 02/11/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION A high degree of suspicion for spinal injury after trauma is commonplace in an emergency department, and spinal immobilization is considered an accepted intervention to prevent the progression of a potential injury. This systematic review was conducted to gain insight into the best research evidence related to nursing interventions for patients with trauma presenting with a suspected spinal injury. METHODS A systematic search of online databases was conducted in April 2019 for relevant research using specific search terms. The studies were selected on the basis of pre-established eligibility criteria, and the quality was appraised using the Critical Appraisal Skills Programme tool. RESULTS Nineteen included articles were synthesized thematically on the basis of the outcomes from interventions directed at a suspected spinal injury. The main findings were that spinal immobilization may compromise pulmonary function and airway management, cause pain and pressure ulcers, and be inappropriate with penetrating trauma. Furthermore, there was insufficient evidence to support the safety and efficacy of the hard neck collar and long backboard. DISCUSSION Patients would benefit from a more selective and cautious approach to spinal immobilization. Emergency nurses should use the evidence to facilitate informed decision-making in balancing the benefits of spinal immobilization against harm when considering the needs and values of the patient.
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Cervical Spine Clearance in Trauma Patients with an Unreliable Physical Examination. World J Surg 2020; 44:1113-1120. [PMID: 31802188 DOI: 10.1007/s00268-019-05307-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The objective of this study was to describe and compare the timing of cervical spine clearance in trauma patients with an unreliable physical examination. METHODS We prospectively included adult trauma patients admitted with a cervical collar and an unreliable clinical examination (as defined by the NEXUS criteria) at two level 1 trauma centers: one in the USA (US) and one in Denmark (DK). We excluded patients with cervical spine injuries requiring a collar or surgery as treatment and patients with a collar placed after hospital arrival. The primary outcome was time from emergency department (ED) arrival to collar removal. Secondary outcomes included time to CT of the cervical spine (CTCS). At the US trauma center, an institutional protocol allowing cervical spine clearance exclusively by CTCS was in place. At the Danish trauma center, cervical spine clearance was based on a clinical evaluation by an orthopedic surgeon, usually after CTCS. RESULTS A total of 113 patients were included (US: n = 56; DK: n = 57). The median age was 47 years, and 68% were males. The main reasons for an unreliable physical examination were a Glasgow Coma Scale score below 14 (35%), distracting injuries (26%), cervical spine tenderness (13%) and intoxication (13%). The injury severity score at the US trauma center was higher than at the DK trauma center (median: 17 vs. 11, p = 0.03). Both time to CTCS (median: 41 vs. 18 min, p < 0.0001) and time to collar removal (median: 1042 vs. 49 min, p < 0.0001) were significantly greater at the US trauma center. CONCLUSIONS Time to collar removal was significantly greater in a trauma center utilizing a cervical spine clearance protocol based on CTCS. As patients may develop complications related to the collar, future studies should clarify how early removal can be implemented without increasing the risk of morbidity.
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Evidence for the use of spinal collars in stabilising spinal injuries in the pre-hospital setting in trauma patients: a systematic review. Eur J Trauma Emerg Surg 2020; 48:647-657. [PMID: 33346863 PMCID: PMC8825572 DOI: 10.1007/s00068-020-01576-x] [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] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/07/2020] [Indexed: 11/04/2022]
Abstract
Purpose Spinal collars were introduced in 1967 into the management of spinal trauma care as it was thought that this technique of immobilisation would prevent any further neurological or spinal damage in high-risk patients. The aim of this systematic review was to determine whether the use of spinal collars in the pre-hospital trauma patient was recommended by published literature. Methods A systematic search of the literature was conducted between 1990 and 2020, screening PubMed, Medline, Science Direct and Google Scholar. The consequent findings were then qualitatively synthesised with the aim of effectively evaluating the evidence to resolve the discrepancy between current practice and literature. Results Of the nine eligible studies, six deemed that spinal collars should not be used in pre-hospital trauma patients with the remaining three reporting uncertainty if spinal collars were best practice. Our results suggest that there is a discrepancy between current guidance and practice in that although the guidelines recommend the use of spinal collars in the pre-hospital setting the majority of the studies were against the use of spinal collars. Importantly, none of the studies reported any benefits of spinal collars. Conclusion Our study shows a disparity between current guidelines and the published literature and warrants further direct research to obtain a more comprehensive view of the use of spinal collars in a pre-hospital setting.
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The Effects of Positional Change on Hemodynamic Parameters in Spinal Immobilization. Prehosp Disaster Med 2020; 36:67-73. [PMID: 33143779 DOI: 10.1017/s1049023x20001338] [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: 11/07/2022]
Abstract
INTRODUCTION The use of a long backboard and cervical collar are commonly recommended by international guidelines for spinal immobilization, but both devices may cause several side effects. In a recent study, it was reported that spinal immobilization at 20° eliminated the decrease in pulmonary function secondary to spinal immobilization performed at 0°. Spinal immobilization at 20° is a new recommendation, but other potential effects need to be explored before it can be implemented in clinical use. STUDY OBJECTIVE Hemodynamic observation is important in the management of trauma patients. The aim of this study was to investigate the effect of spinal immobilization at a 20° position instead of 0° on hemodynamic parameters. METHODS This study included 53 healthy volunteers who underwent spinal immobilization in the supine position (00) and in an elevated position (200). Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), left ventricular outflow tract velocity time integral (LVOT-VTI), left ventricular stroke volume (LVSV), cardiac output (CO), inferior vena cava diameter inspiration (IVC diameter insp), IVC diameter expiration (IVC diameter exp), and inferior vena cava collapsibility index (IVC-CI) were measured at the 0th and 30th minutes of spinal immobilization in both positions. The data were compared for demonstrating the efficiency of both positions in spinal immobilization. RESULTS A statistically significant difference was found in the parameters of the IVC diameter (exp), IVC diameter (insp), LVOT-VTI, LVSV, and CO through the measurements starting in the 0th minute of the transition from 0° to 20° (P <.001). Delta values (∆) of hemodynamic parameters (∆IVC diameter [exp], ∆IVC diameter [insp], ∆LVOT-VTI, ∆SV, ∆CO, ∆IVC-CI, ∆MAP, ∆SAP, ∆DAP, and ∆HR) were similar in spinal immobilization at 0° and 20°. CONCLUSION The findings obtained from this study illustrate that spinal immobilization at 20° does not cause clinically significant hemodynamic changes in healthy subjects compared to spinal immobilization at 0°.
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Lacey L, Palokas M, Walker J. Preventative interventions, protocols or guidelines for trauma patients at risk of cervical collar-related pressure ulcers: a scoping review. ACTA ACUST UNITED AC 2020; 17:2452-2475. [PMID: 31464850 DOI: 10.11124/jbisrir-2017-003872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review was to explore the existing literature related to preventative interventions, protocols or guidelines for trauma patients at risk of cervical collar-related pressure ulcers to examine and conceptually map the evidence, and to identify any gaps in the literature. INTRODUCTION Cervical collars are necessary to stabilize cervical spine injuries in trauma patients; however, pressure ulcers are a major complication of prolonged cervical collar use. The longer a patient wears a cervical collar, the more likely the patient will develop a pressure ulcer that will worsen as wear time increases. INCLUSION CRITERIA This review considered both experimental and quasi-experimental study designs, analytical observational studies, case-control studies, analytical cross-sectional studies, descriptive observational studies, qualitative studies, and text and opinion papers. Trauma patients of all ages who presented to the emergency department or intensive care unit with an extrication or field collar in place were included in this study. Extrication collars included but were not limited to Stifneck, Philadelphia and Miami J. METHODS The JBI scoping review methodology was used for this review. The database searches included MEDLINE (PubMed), CINAHL, Embase, Scopus, JBI Database of Systematic Reviews and Implementation Reports, NHS Research Register, National Institute of Health Clinical Trial Databases, Cochrane Database of Sytematic Reviews, MedNar, WorldWideScience, PsycEXTRA, OAIster, OpenGrey, and ProQuest Dissertations and Theses. The data were extracted using a charting table, which was developed to record key information from sources relevant to the review questions. The findings were descriptively presented, with tables and figures to support the data, when appropriate. Only studies in English from 1965 to December 2018 were included. RESULTS Preventative interventions found in the seven studies included in the review were: removal of the extrication collar, cervical spine clearance, nursing education, routine nursing care, use of products such as air mattresses, and a multidisciplinary approach to care. Additionally, six of the seven studies identified 28 risk factors associated with the development of cervical collar-related pressure ulcers. Two studies reported elimination of cervical collar-related pressure ulcers while three studies reported reduced incidence in cervical collar-related pressure ulcers. Another study reported a reduction in cervical collar wear time from 14 days to 7.7 days. CONCLUSIONS Protocols with a multidisciplinary approach are available in the literature to serve as guidance for proper treatment and care of trauma patients' wearing of cervical collars. Standardized cervical collar protocols should highlight the importance of early identification of trauma patients who may be at risk. Risk factors identified in this review should be assessed and addressed to halt cervical collar-related pressure ulcers from ever developing in trauma patients who are immediately identified as at risk. Preventative interventions identified in the protocols in this scoping review can be used to create a standardized approach to care for patients in cervical collars.
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Affiliation(s)
- Lanise Lacey
- School of Nursing, University of Mississippi Medical Center, Jackson, United States.,Mississippi Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
| | - Michelle Palokas
- Mississippi Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
| | - Jean Walker
- Mississippi Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
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Häske D, Lefering R, Stock JP, Kreinest M. Epidemiology and predictors of traumatic spine injury in severely injured patients: implications for emergency procedures. Eur J Trauma Emerg Surg 2020; 48:1975-1983. [PMID: 33025171 PMCID: PMC9192373 DOI: 10.1007/s00068-020-01515-w] [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: 07/29/2020] [Accepted: 09/25/2020] [Indexed: 10/30/2022]
Abstract
PURPOSE This study aimed to identify the prevalence and predictors of spinal injuries that are suitable for immobilization. METHODS Retrospective cohort study drawing from the multi-center database of the TraumaRegister DGU®, spinal injury patients ≥ 16 years of age who scored ≥ 3 on the Abbreviated Injury Scale (AIS) between 2009 and 2016 were enrolled. RESULTS The mean age of the 145,833 patients enrolled was 52.7 ± 21.1 years. The hospital mortality rate was 13.9%, and the mean injury severity score (ISS) was 21.8 ± 11.8. Seventy percent of patients had no spine injury, 25.9% scored 2-3 on the AIS, and 4.1% scored 4-6 on the AIS. Among patients with isolated traumatic brain injury (TBI), 26.8% had spinal injuries with an AIS score of 4-6. Among patients with multi-system trauma and TBI, 44.7% had spinal injuries that scored 4-6 on the AIS. Regression analysis predicted a serious spine injury (SI; AIS 3-6) with a prevalence of 10.6% and cervical spine injury (CSI; AIS 3-6) with a prevalence of 5.1%. Blunt trauma was a predictor for SI and CSI (OR 4.066 and OR 3.640, respectively; both p < 0.001) and fall > 3 m for SI (OR 2.243; p < 0.001) but not CSI (OR 0.636; p < 0.001). Pre-hospital shock was predictive for SI and CSI (OR 1.87 and OR 2.342, respectively; both p < 0.001), and diminished or absent motor response was also predictive for SI (OR 3.171) and CSI (OR 7.462; both p < 0.001). Patients over 65 years of age were more frequently affected by CSI. CONCLUSIONS In addition to the clinical symptoms of pain, we identify '4S' [spill (fall) > 3 m, seniority (age > 65 years), seriously injured, skull/traumatic brain injury] as an indication for increased attention for CSIs or indication for spinal motion restriction.
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Affiliation(s)
- David Häske
- German Red Cross, Emergency Medical Service, Obere Wässere 1, 72764, Reutlingen, Germany. .,Center for Public Health and Health Services Research, University Hospital Tübingen, Tübingen, Germany.
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany
| | - Jan-Philipp Stock
- Department of Anesthesiology, Intensive Care Medicine, Emergency and Pain Medicine, Klinikum am Steinenberg, Reutlingen, Germany
| | - Michael Kreinest
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
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A T2 Translational Science Modified Delphi Study: Spinal Motion Restriction in a Resource-Scarce Environment. Prehosp Disaster Med 2020; 35:538-545. [PMID: 32641192 DOI: 10.1017/s1049023x20000862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Emerging evidence is guiding changes in prehospital management of potential spinal injuries. The majority of settings related to current recommendations are in resource-rich environments (RREs), whereas there is a lack of guidance on the provision of spinal motion restriction (SMR) in resource-scarce environments (RSEs), such as: mass-casualty incidents (MCIs); low-middle income countries; complex humanitarian emergencies; conflict zones; and prolonged transport times. The application of Translational Science (TS) in the Disaster Medicine (DM) context was used to develop this study, leading to statements that can be used in the creation of evidence-based clinical guidelines (CGs). OBJECTIVE What is appropriate SMR in RSEs? METHODS The first round of this modified Delphi (mD) study was a structured focus group conducted at the World Association for Disaster and Emergency Medicine (WADEM) Congress in Brisbane Australia on May 9, 2019. The result of the focus group discussion of open-ended questions produced ten statements that were added to ten statements derived from Fischer (2018) to create the second mD round questionnaire.Academic researchers and educators, operational first responders, or first receivers of patients with suspected spinal injuries were identified to be mD experts. Experts rated their agreement with each statement on a seven-point linear numeric scale. Consensus amongst experts was defined as a standard deviation ≤1.0. Statements that were in agreement reaching consensus were included in the final report; those that were not in agreement but reached consensus were removed from further consideration. Those not reaching consensus advanced to the third mD round.For subsequent rounds, experts were shown the mean response and their own response for each of the remaining statements and asked to reconsider their rating. As above, those that did not reach consensus advanced to the next round until consensus was reached for each statement. RESULTS Twenty-two experts agreed to participate with 19 completing the second mD round and 16 completing the third mD round. Eleven statements reached consensus. Nine statements did not reach consensus. CONCLUSIONS Experts reached consensus offering 11 statements to be incorporated into the creation of SMR CGs in RSEs. The nine statements that did not reach consensus can be further studied and potentially modified to determine if these can be considered in SMR CGs in RSEs.
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Indentation marks, skin temperature and comfort of two cervical collars: A single-blinded randomized controlled trial in healthy volunteers. Int Emerg Nurs 2020; 51:100878. [PMID: 32505019 DOI: 10.1016/j.ienj.2020.100878] [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: 10/19/2019] [Revised: 04/07/2020] [Accepted: 05/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Collar-related pressure ulcers (CRPU) are a problem in trauma patients with a suspicion of cervical cord injury patients. Indentation marks (IM), skin temperature (Tsk) and comfort could play a role in the development of CRPU. Two comparable cervical collars are the Stifneck® and Philadelphia®. However, the differences between them remain unclear. AIM To determine and compare occurrence and severity of IM, Tsk and comfort of the Stifneck® and Philadelphia® in immobilized healthy adults. METHODS This single-blinded randomized controlled trial compared two groups of immobilized participants in supine position for 20 min. RESULTS All participants (n = 60) generated IM in at least one location in the observed area. Total occurrence was higher in the Stifneck®-group (n = 95 versus n = 69; p = .002). Tsk increased significantly with 1.0 °C in the Stifneck®-group and 1.3 °C in the Philadelphia®-group (p = .024). Comfort was rated 3 on a scale of 5 (p = .506). CONCLUSION The occurrence of IM in both groups was high. In comparison to the Stifneck®, fewer and less severe IM were observed from the Philadelphia®. The Tsk increased significantly with both collars; however, no clinical difference in increase of Tsk between them was found. The results emphasize the need for a better design of cervical collars regarding CRPU.
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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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Wang HRN, Campbell J, Doubrovsky A, Singh V, Collins J, Coyer F. Pressure injury development in critically ill patients with a cervical collar in situ: A retrospective longitudinal study. Int Wound J 2020; 17:944-956. [PMID: 32239663 DOI: 10.1111/iwj.13363] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 11/27/2022] Open
Abstract
Trauma patients with a serious injury to the head or neck can remain immobilised with a cervical collar (C-collar) device in situ and are subsequently exposed to device-related skin integrity threats. This study aimed to determine the incidence and risk factors associated with the development of C-collar-related pressure injures (CRPIs) in an intensive care unit. This retrospective longitudinal cohort study was conducted in an Australian metropolitan intensive care unit. Following ethical approval, data from patients over 18 years, who received a C-collar were retrieved over a 9-year period. Chi square and t-tests were used to identify variables associated with CRPI development. A logistic regression model was employed to analyse the risk factors. Data from 906 patients were analysed. Nine-year pressure injury incidence was 16.9% (n = 154/906). Pressure injury development directly associated with a C-collar increased by 33% with each repositioning episode (odds ratio 1.328, 95% confidence interval 1.024-1.723, P = .033). Time in the C-collar (10.4 to 2.5 days, P = .002) and length of stay in intensive care unit (ICU) (20.1 to 16.1 days, P < .001) were associated with pressure injury development. Patients with C-collar devices are a vulnerable group at risk for pressure injury development because of their immobility and length of ICU stay.
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Affiliation(s)
- Harn-Rong N Wang
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Jill Campbell
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Skin Integrity Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Anna Doubrovsky
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | | | | | - Fiona Coyer
- Joint appointment Intensive Care Services, Royal Brisbane and Women's Hospital and School of Nursing, Queensland University of Technology, Herston, Queensland, Australia.,Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
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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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Sun H, Wilson J, Roach MJ, Hefzy MS, Nemunaitis G. Demonstration of pressure reduction in a new proof of concept spine board. Assist Technol 2019; 33:341-349. [PMID: 31437094 DOI: 10.1080/10400435.2019.1658658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Pressure injuries are a significant problem following spinal cord injury (SCI). High interface pressures while lying on a spine board during emergency transport appear to play a major role in their formation. The aim of the present study was to assess the interface pressures and sensing area between the body and the standard spine board (SSB) and a proof of concept spine board prototype (P-5). Twenty-one able-bodied subjects were assessed on each board. Interface pressures and sensing area were recorded every minute over 15 min. The mean peak pressure was higher on the SSB at the head, scapulothoracic (S-T), sacroiliac (S-I), and heels (227.6 mmHg, 148.9 mmHg, 360.3 mmHg, and 179.3 mmHg) compared to P-5 (51.9 mmHg, 60.1 mmHg, 66.8 mmHg, and 60.2 mmHg). The peak pressure index (PPI) at the head, S-T and S-I was higher on the SSB (100.2 mmHg, 101.6 mmHg, and 270.6 mmHg) compared to P-5 (41.6 mmHg, 51.9 mmHg and 58.7 mmHg). An analysis using pairwise comparisons for repeated measures showed that interface pressures (p < .05) and PPI (p < .001) were reduced at all locations. Modifications of a spine board incorporated in P-5 can dramatically reduce interface pressures and reduce pressure injury formation.
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Affiliation(s)
- Helen Sun
- Case Western Reserve University School of Medicine , Cleveland , Ohio , USA
| | - James Wilson
- Case Western Reserve University School of Medicine , Cleveland , Ohio , USA.,Department of Physical Medicine and Rehabilitation, Veterans Affairs Northeast Ohio Healthcare System , Cleveland , OH , USA
| | - Mary Joan Roach
- Case Western Reserve University School of Medicine , Cleveland , Ohio , USA.,MetroHealth Rehabilitation Institute, Cleveland , Ohio , USA.,Center for Health Research and Policy , Cleveland , Ohio , USA
| | - Mohamed Samir Hefzy
- Department of Mechanical, Industrial and Manufacturing Engineering, University of Toledo , Toledo , Ohio , USA
| | - Greg Nemunaitis
- Case Western Reserve University School of Medicine , Cleveland , Ohio , USA.,Center for Health Research and Policy , Cleveland , Ohio , USA
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Shi C, Bonnett L, Dumville J, Cullum N. Nonblanchable erythema for predicting pressure ulcer development: a systematic review with an individual participant data meta‐analysis. Br J Dermatol 2019; 182:278-286. [DOI: 10.1111/bjd.18154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2019] [Indexed: 12/16/2022]
Affiliation(s)
- C. Shi
- Division of Nursing, Midwifery& Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health University of Manchester, Manchester Academic Health Science Centre Manchester M13 9PL U.K
| | - L.J. Bonnett
- Department of Biostatistics University of Liverpool Waterhouse Building, Block F, 1–5 Brownlow Street Liverpool L69 3GL U.K
| | - J.C. Dumville
- Division of Nursing, Midwifery& Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health University of Manchester, Manchester Academic Health Science Centre Manchester M13 9PL U.K
| | - N. Cullum
- Division of Nursing, Midwifery& Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health University of Manchester, Manchester Academic Health Science Centre Manchester M13 9PL U.K
- Research and Innovation Division Manchester University NHS Foundation Trust Manchester Academic Health Science Centre 1st Floor, Nowgen Building, 29 Grafton Street Manchester M13 9WU U.K
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Ottosen CI, Steinmetz J, Larsen MH, Baekgaard JS, Rasmussen LS. Patient experience of spinal immobilisation after trauma. Scand J Trauma Resusc Emerg Med 2019; 27:70. [PMID: 31331379 PMCID: PMC6647237 DOI: 10.1186/s13049-019-0647-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/15/2019] [Indexed: 11/06/2022] Open
Abstract
Background Spinal immobilisation of blunt trauma victims with potential spinal cord injury is considered standard of care. The traditional management has, however, been increasingly questioned and concerns about harm have been raised. Few studies have described the perspective of the trauma patient regarding the spinal immobilisation. The objective of this study was therefore to evaluate the patient experience of immobilisation after trauma. Methods We prospectively screened adult trauma patients admitted to a level 1 trauma centre for eligibility. We included adult trauma patients who had been, and remembered being, immobilised for spinal protection with a cervical collar and a spine board prehospitally or upon arrival at the trauma centre. A semi-structured interview was conducted 2 to 72 h after admission either in person or by telephone. Results One hundred and fourteen patients were eligible for inclusion based on the patient charts. Out of 98 patients assessed for participation, 48 (49%) had no memory of being immobilised. We thus included 50 patients with a median age of 37 years (IQR: 26–60) of whom 38 (76%) were men. The median injury severity score was 9 (IQR: 3–15) and the median time with a cervical collar from initial application to in-hospital removal or until the interview was given was 91 min (IQR: 72–136). Nineteen patients (38%) reported discomfort and 12 patients (24%) experienced pain related to the immobilisation. Forty patients (80%) reported a sense of protection related to the immobilisation. Conclusion Discomfort related to spinal immobilisation was reported in 38% of trauma patients. However, a sense of protection was a recurring theme in 80% of the trauma patients, who recalled being immobilised. Nearly half of the awake trauma patients had no memory of being immobilised.
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Affiliation(s)
- Camilla Ikast Ottosen
- Department of Anaesthesia, Section 4231, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Juliane Maries Vej 10, DK-2100, Copenhagen, Denmark.
| | - Jacob Steinmetz
- Department of Anaesthesia, Section 4231, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Juliane Maries Vej 10, DK-2100, Copenhagen, Denmark.,Trauma Centre, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mo Haslund Larsen
- Department of Anaesthesia, Section 4231, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Juliane Maries Vej 10, DK-2100, Copenhagen, Denmark
| | - Josefine S Baekgaard
- Department of Anaesthesia, Section 4231, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Juliane Maries Vej 10, DK-2100, Copenhagen, Denmark
| | - Lars S Rasmussen
- Department of Anaesthesia, Section 4231, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Juliane Maries Vej 10, DK-2100, Copenhagen, Denmark
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Mitra B, El-Menyar A, Mercier E, Liew S, Varma D, Fitzgerald MC, Al-Hilli S, Peralta R, Al-Thani H, Cameron PA. Clinical clearance of the thoracic and lumbar spine: a pilot study. ANZ J Surg 2019; 89:718-722. [PMID: 31083786 DOI: 10.1111/ans.15253] [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: 02/07/2019] [Revised: 03/21/2019] [Accepted: 03/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND In patients who are awake with normal mental and neurologic status, it has been suggested that the thoracolumbar (TL) spine may be cleared by clinical examination, irrespective of the mechanism of injury. The aim of this pilot study was to test the feasibility and accuracy of a clinical decision tool focused towards clearance of the TL spine during assessment of patients in the emergency department after trauma. METHODS A prospective interventional study was conducted at two major trauma centres. The intervention of a clinical decision tool for assessment of the TL spine was applied prospectively to all patients with subsequent imaging results acting as the comparator. The primary outcome variable was fracture of the thoracic or lumbar vertebra(e). The clinical decision tool was assessed using sensitivity and specificity for detecting a TL fracture and reported with 95% confidence intervals (CIs). RESULTS There were 188 cases included for analysis that all underwent imaging of the thoracic and/or lumbar vertebrae. There were 34 (18%) patients diagnosed with fractures of the thoracic and/or lumbar vertebrae. In this pilot study, sensitivity of the clinical decision tool was 100% (95% CI 87.3-100%) and specificity was 37.0% (95% CI 29.5-45.2%) for the detection of a thoracic or lumbar vertebral fracture. CONCLUSIONS Feasibility of clinical clearance of the TL spine in two major trauma centres was demonstrated in a clinical study setting. Evaluation of this clinical decision tool in patients following blunt trauma, particularly in reducing imaging rates, is indicated using a larger prospective study.
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Affiliation(s)
- Biswadev Mitra
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Ayman El-Menyar
- Department of Surgery, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha, Qatar.,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Eric Mercier
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices, Université Laval, Québec, Canada.,Département de Médecine Familiale et Médecine d'Urgence, Faculté de Médecine, Université Laval, Québec, Canada.,Centre de Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval, Québec, Canada
| | - Susan Liew
- Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Dinesh Varma
- Department of Radiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Mark C Fitzgerald
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Shatha Al-Hilli
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha, Qatar.,Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Peter A Cameron
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
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Analysis of cervical spine immobilization during patient transport in emergency medical services. Eur J Trauma Emerg Surg 2019; 47:719-726. [PMID: 31030223 DOI: 10.1007/s00068-019-01143-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/22/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE It remains controversial how to immobilize the cervical spine (CS) in trauma patients. Therefore, we analyzed different CS immobilization techniques during prehospital patient transport. METHODS In this explorative, biomechanical analysis of immobilization techniques conducted in a standardized setting, we recorded CS motion during patient transport using a wireless human motion tracker on a volunteer. To interpret spinal movement a benchmark called motionscore (MS) was developed based on biomechanics of the injured spine. RESULTS We found the best spinal motion restriction using a spine board, head blocks and immobilization straps with and without a cervical collar (CC) (MS 45 vs. 27). Spinal motion restriction on a vacuum mattress with CC and head blocks was superior to no CC or head blocks (MS 103 vs. 152). An inclined vacuum mattress was more effective with head blocks than without (MS 124 vs. 187). Minimal immobilization with an ambulance cot, CC, pillow and tape was slightly superior to a vacuum mattress with CC and head blocks (MS 92 vs. 103). Minimal immobilization without CC showed the lowest spinal motion restriction (MS 517). CONCLUSIONS We suggest an immobilization procedure customized to the individual situation. A spine board should be used whenever spinal motion restriction is indicated and the utilization is possible. In some cases, CS immobilization by a vacuum mattress with CC and head blocks could be more beneficial. In an unstable status of the patient, minimal immobilization may be performed using an ambulance cot, pillow, CC and tape to minimize time on scene caused by immobilization.
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Galganski LA, Cox JA, Greenhalgh DG, Sen S, Romanowski KS, Palmieri TL. Cervical Spine Injury in Burned Trauma Patients: Incidence, Predictors, and Outcomes. J Burn Care Res 2019; 40:263-268. [PMID: 30801641 DOI: 10.1093/jbcr/irz022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cervical spine injuries (CIs) carry significant morbidity and mortality; hence, cervical spine immobilization is used liberally in trauma patients, including burns. The incidence, predictors, and outcomes of CI in burn patients are unknown. A retrospective cohort from the National Trauma Data Bank between 2007 and 2012 included all burned patients with and without CI. Predictors of CI were identified by logistic regression. Outcomes with and without CI were compared with Wilcoxon rank sum test. A total of 94,964 patients were identified with burn injuries. The incidence of CI was 0.79% (n = 745). Mechanism of injury, age, and injury severity score (ISS) were significant predictors of CI. Odds of CI were 109.4 (95% CI: 61.2-195.3, P < .0001) for motor vehicle injury, 87.8 (95% CI: 47.0-164.0, P < .0001) for falls, 1.2 (95% CI: 0.6-2.3, P = .66) for fire/flame, and 2.4 (95% CI: 1.0-5.5, P < .0001) for explosion compared with reference of hot object/substance. For every year increase in age, there were 1.02 higher odds of CI (95% CI: 1.01-1.02, P < .0001). For each point increase in ISS, there were 1.05 higher odds of CI (95% CI: 1.04-1.05, P < .0001). Patients with CI had higher mortality (10.3% vs 2.9%, P < .0001), longer total length of stay (12.0 vs 2.0 days, P < .0001), intensive care unit length of stay (4.0 vs 0.0 days, P < .001), and ventilator days (1.0 vs 0.0 days, P < .0001). The incidence of CI in burn patients is low, especially when due to fire, flame, or scalds; however, CI is associated with higher mortality and worse outcomes.
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Affiliation(s)
- Laura A Galganski
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California.,Shriners Hospital for Children - Northern California, Sacramento, California
| | - Jessica A Cox
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California.,Shriners Hospital for Children - Northern California, Sacramento, California
| | - David G Greenhalgh
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California.,Shriners Hospital for Children - Northern California, Sacramento, California
| | - Soman Sen
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California.,Shriners Hospital for Children - Northern California, Sacramento, California
| | - Kathleen S Romanowski
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California.,Shriners Hospital for Children - Northern California, Sacramento, California
| | - Tina L Palmieri
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California.,Shriners Hospital for Children - Northern California, Sacramento, California
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Ward CE, Badolato GM, Breslin K, Brown K, Simpson JN. Evaluation of a Selective Prehospital Pediatric Spinal Protection Protocol. PREHOSP EMERG CARE 2019; 23:862-869. [DOI: 10.1080/10903127.2019.1585502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
STUDY DESIGN This was a prospective simulator study with 16 healthy male subjects. OBJECTIVE The aim of this study was to compare the relative efficacy of immobilization systems in limiting involuntary movements of the cervical spine using a dynamic simulation model. SUMMARY OF BACKGROUND DATA Relatively few studies have tested the efficacy of immobilization methods for limiting involuntary cervical movement, and only one of these studies used a dynamic simulation system to do so. METHODS Immobilization configurations tested were cot alone, cot with cervical collar, long spine board (LSB) with cervical collar and head blocks, and vacuum mattress (VM) with cervical collar. A motion platform reproduced shocks and vibrations from ambulance and helicopter field rides, as well as more severe shocks and vibrations that might be encountered on rougher terrain and in inclement weather (designated as an "augmented" ride). Motion capture technology quantitated involuntary cervical rotation, flexion/extension, and lateral bend. The mean and 95% confidence interval of the mean were calculated for the root mean square of angular changes from the starting position and for the maximum range of motion. RESULTS All configurations tested decreased cervical rotation and flexion/extension relative to the cot alone. However, the LSB and VM were significantly more effective in decreasing cervical rotation than the cervical collar, and the LSB decreased rotation more than the VM in augmented rides. The LSB and VM, but not the cervical collar, significantly limited cervical lateral bend relative to the cot alone. CONCLUSION Under the study conditions, the LSB and the VM were more effective in limiting cervical movement than the cervical collar. Under some conditions, the LSB decreased repetitive and acute movements more than the VM. Further studies using simulation and other approaches will be essential for determining the safest, most effective configuration should providers choose to immobilize patients with suspected spinal injuries. LEVEL OF EVIDENCE 3.
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Skin status for predicting pressure ulcer development: A systematic review and meta-analyses. Int J Nurs Stud 2018; 87:14-25. [DOI: 10.1016/j.ijnurstu.2018.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/15/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
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Paschou SA, Stamou M, Vuagnat H, Tentolouris N, Jude E. Pain management of chronic wounds: Diabetic ulcers and beyond. Maturitas 2018; 117:17-21. [DOI: 10.1016/j.maturitas.2018.08.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/02/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
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