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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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López-González Á, Rabanales-Sotos J, Guerrero-Agenjo CM, López-Tendero J, López-Torres Hidalgo J, Guisado-Requena IM. Analysis of compliance of the criteria recommended by the European resucitation council in first aid books published in Spanish. Int Emerg Nurs 2021; 55:100958. [PMID: 33545612 DOI: 10.1016/j.ienj.2020.100958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/03/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
AIMS Analyse the compliance of criteria recommended by the European Resuscitation Council (ERC) in the layperson First Aid (FA) and Cardiopulmonary resuscitation (CPR) books published in Spanish. METHODS A review of FA literature published in Spain, carried out through a systematic literature search procedure. We drew up a checklist with clarifications, based on different responses to twenty categories published in November 2015 by the ERC. The validity of the questions was analysed using the Fleiss' Kappa measure of inter-rater reliability, with a value >0.7 being deemed valid and questions displaying the lowest level of agreement being excluded. RESULTS Eight texts obtained from the limited search of materials published between 2016-2020 in the ISBN 13 database were analysed. Evaluation of eight texts ranging from 47 to 328 pages in length showed that only three included the upgraded 2015 CPR recommendations. Twenty categories/items were analysed, after exclusion of categories/items that displayed a low consistency. None of the handbooks was in total compliance with the new CPR recommendations, and only one included 70% of the recommendations. Seven categories were included in more than 50% of the texts, and nine categories were not included in any of them. CONCLUSIONS There is a gap between the 2015 CPR recommendations and those published in Spanish FA handbooks. The ERC Guidelines should serve to standardise FA and CPR training materials. Systematic analysis of compliance with scientific societies' recommendations for FA handbooks enables detection of guidelines and patterns that need to be updated and adapted.
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Affiliation(s)
- Ángel López-González
- Group of Preventive Activities in the University Field of Health sciences, University of Castilla-La Mancha (Universidad de Castilla-La Mancha/UCLM), Spain; Albacete Faculty of Nursing, University of Castilla-La Mancha (Universidad de Castilla-La Mancha/UCLM), Spain
| | - Joseba Rabanales-Sotos
- Group of Preventive Activities in the University Field of Health sciences, University of Castilla-La Mancha (Universidad de Castilla-La Mancha/UCLM), Spain; Albacete Faculty of Nursing, University of Castilla-La Mancha (Universidad de Castilla-La Mancha/UCLM), Spain.
| | | | | | - Jesús López-Torres Hidalgo
- Group of Preventive Activities in the University Field of Health sciences, University of Castilla-La Mancha (Universidad de Castilla-La Mancha/UCLM), Spain; Albacete Zone VIII Health Centre and Faculty of Medicine, University of Castilla-La Mancha (Universidad de Castilla-La Mancha/UCLM), Spain
| | - Isabel Mª Guisado-Requena
- Group of Preventive Activities in the University Field of Health sciences, University of Castilla-La Mancha (Universidad de Castilla-La Mancha/UCLM), Spain; Albacete Faculty of Nursing, University of Castilla-La Mancha (Universidad de Castilla-La Mancha/UCLM), Spain
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Chang SW, Choi KK, Kim OH, Kim M, Lee GJ. Part 4. Clinical Practice Guideline for Surveillance and Imaging Studies of Trauma Patients in the Trauma Bay from the Korean Society of Traumatology. JOURNAL OF TRAUMA AND INJURY 2020. [DOI: 10.20408/jti.2020.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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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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Gabrieli A, Nardello F, Geronazzo M, Marchetti P, Liberto A, Arcozzi D, Polati E, Cesari P, Zamparo P. Cervical Spine Motion During Vehicle Extrication of Healthy Volunteers. PREHOSP EMERG CARE 2019; 24:712-720. [PMID: 31750763 DOI: 10.1080/10903127.2019.1695298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Prehospital spinal motion restriction as a prevention technique for secondary neurological injury is a key principle in emergency medicine. Our aim was to evaluate the effectiveness of different cervical spinal cord motion restriction techniques of awake and cooperative healthy volunteers during extrication.Methods: Twenty-three healthy volunteers were asked to exit a car (unassisted) with a rigid cervical collar (CC condition) or without it (autonomous exit: AE; instructed exit: IE); they were also extricated by two rescuers after setting a rigid cervical collar and by using an extrication device (CC + XT condition). Eight 3 D infrared cameras were calibrated around the vehicle to measure cervical spine angle, angular speed and acceleration in the sagittal plane. Surface wireless EMG electrodes were used to record superior trapezius, erector spinae and rectus abdominis muscle activity. All measures were recorded during two phases: device positioning (maneuver) and vehicle exiting.Results: The lowest range of motion was observed in CC during maneuver and exit (about 17°), the greatest in AE and IE (about 45°); when the extrication device was utilized along with the cervical collar (CC + XT) an increase, rather than a further decrease, in the range of motion was observed (about 25° during maneuver and exit). Larger values of angular speed and acceleration were observed in CC + XT when compared to CC, both during maneuver and exit (p < 0.001). The lowest EMG activity was observed during maneuver in CC and CC + XT; during exit a lower EMG activity was observed in CC + XT compared to CC (p < 0.001). Thus, when an extrication device is utilized (CC + XT), a lower active control of the cervical spine region is associated with faster and more brisk movements of the cervical spine compared to CC alone.Conclusions: Our findings support the idea that spinal motion restriction via rigid cervical collar of awake and cooperative trauma patients is effective in reducing cervical spine motion in the sagittal plane during vehicle extrication.
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Phaily A, Khan M. Is our current method of cervical spine control doing more harm than good? TRAUMA-ENGLAND 2018. [DOI: 10.1177/1460408618777773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gordillo Martin R, Alcaráz PE, Rodriguez LJ, Fernandez-Pacheco AN, Marín-Cascales E, Freitas TT, Rios MP. Effect of training in advanced trauma life support on the kinematics of the spine: A simulation study. Medicine (Baltimore) 2017; 96:e7587. [PMID: 29310322 PMCID: PMC5728723 DOI: 10.1097/md.0000000000007587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
More than 7.5 million people in the world are affected by spinal cord injury (SCI). In this study, we aimed to analyze the effect of training in advanced trauma life support (ATLS) on the kinematics of the spine when performing different mobilization and immobilization techniques on patients with suspected SCI. A quasi-experimental study, clinical simulation, was carried out to determine the effect of training in ATLS on 32 students enrolled in the Master's program of Emergency and Special Care Nursing. The evaluation was performed through 2 maneuvers: placing of the scoop stretcher (SS) and spinal board (SB), with an actor who simulated a clinical situation of suspected spinal injury. The misalignment of the spine was measured with the use of a Vicon 3D motion capture system, before (pre-test) and after (post-test) the training. In the overall misalignment of both maneuvers, statistically significant differences were found between the pre-test misalignment of 62.1° ± 25.9°, and the post-test misalignment of 32.3° ± 10.0°, with a difference between means of 29.7° [(95% confidence interval, 95% CI 22.8-36.6°), (P = .001)]. The results obtained for the placing of the SS showed that there was a pre-test misalignment of 65.1° ± 28.7°, and a post-test misalignment of 33.2° ± 10.1°, with a difference of means of 33.9° [(95% CI, 23.1-44.6°), (P = .001)]. During the placing of the SB, a pre-test misalignment of 59.0° ± 28.7° and a post-test misalignment of 33.4° ± 10.0° were obtained, as well as a difference of means of 25.6° [(95% CI 16.6-34.6°), (P = .001)]. The main conclusion of this study is that training in ATLS decreases the misalignment provoked during the utilization of the SS and SB, regardless of the device used.
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Affiliation(s)
- Raquel Gordillo Martin
- Doctoral Program in Health Sciences and Professor of the Faculty of Nursing of the Catholic University of Murcia (UCAM) and Nurse in the Emergency Services 061 (112) of Murcia, Spain
| | - Pedro E. Alcaráz
- Director of Research Center for High Performance Sport, Catholic University of Murcia (UCAM)
| | - Laura Juguera Rodriguez
- Professor of the Faculty of Nursing at The Catholic University of Murcia (UCAM) and Nurse in the Emergency Services 061 (112) of Murcia, Spain
| | - Antonio Nieto Fernandez-Pacheco
- Professor of the Faculty of Nursing of the Catholic University of Murcia (UCAM) and Medical Doctor in the Emergency Services 061 (112) of Murcia, Spain
| | - Elena Marín-Cascales
- Researcher at Center for High Performance Sport, Catholic University of Murcia (UCAM)
| | - Tomás T. Freitas
- Researcher at Center for High Performance Sport, Catholic University of Murcia (UCAM)
| | - Manuel Pardo Rios
- Professor of the Faculty of Nursing of the Catholic University of Murcia (UCAM) and Nurse in the Emergency Services 061 (112) of Murcia, Spain
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Hemmes B, de Wert LA, Brink PR, Oomens CW, Bader DL, Poeze M. Cytokine IL1α and lactate as markers for tissue damage in spineboard immobilisation. A prospective, randomised open-label crossover trial. J Mech Behav Biomed Mater 2017; 75:82-88. [DOI: 10.1016/j.jmbbm.2017.06.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 11/29/2022]
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Tatum JM, Melo N, Ko A, Dhillon NK, Smith EJT, Yim DA, Barmparas G, Ley EJ. Validation of a field spinal motion restriction protocol in a level I trauma center. J Surg Res 2017; 211:223-227. [PMID: 28501121 DOI: 10.1016/j.jss.2016.12.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/03/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Spinal motion restriction (SMR) after traumatic injury has been a mainstay of prehospital trauma care for more than 3 decades. Recent guidelines recommend a selective approach with cervical spine clearance in the field when criteria are met. MATERIALS AND METHODS In January 2014, the Department of Health Services of the City of Los Angeles, California, implemented revised guidelines for cervical SMR after blunt mechanism trauma. Adult patients (aged ≥18 y) with an initial Glasgow Coma Scale (GCS) score of ≥13 presented to a single level I trauma center after blunt mechanism trauma over the following 1-y period were retrospectively reviewed. Demographics, injury data, and prehospital data were collected. Cervical spine injury (CSI) was identified by International Classification of Disease, Ninth Revision, codes. RESULTS Emergency medical services transported 1111 patients to the emergency department who sustained blunt trauma. Patients were excluded if they refused c-collar placement or if documentation was incomplete. A total of 997 patients were included in our analysis with 172 (17.2%) who were selective cleared of SMR per protocol. The rate of Spinal Cord Injury was 2.2% (22/997) overall and 1.2% (2/172) in patients without SMR. The sensitivity and specificity of the protocol are 90.9% (95% confidence interval: 69.4-98.4) and 17.4% (95% confidence interval: 15.1-20.0), respectively, for CSI. Patients with CSI who arrived without immobilization having met field clearance guidelines, were managed without intervention, and had no neurologic compromise. CONCLUSIONS Guidelines for cervical SMR have high sensitivity and low specificity to identify CSI. When patients with injuries were not placed on motion restrictions, there were no negative clinical outcomes.
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Affiliation(s)
- James M Tatum
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nicolas Melo
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ara Ko
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Navpreet K Dhillon
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric J T Smith
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dorothy A Yim
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Galinos Barmparas
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric J Ley
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
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Chang CD, Crowe RP, Bentley MA, Janezic AR, Leonard JC. EMS Providers' Beliefs Regarding Spinal Precautions for Pediatric Trauma Transport. PREHOSP EMERG CARE 2016; 21:344-353. [DOI: 10.1080/10903127.2016.1254696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ham WHW, Schoonhoven L, Schuurmans MJ, Leenen LPH. Pressure ulcers, indentation marks and pain from cervical spine immobilization with extrication collars and headblocks: An observational study. Injury 2016; 47:1924-31. [PMID: 27158006 DOI: 10.1016/j.injury.2016.03.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 03/17/2016] [Accepted: 03/25/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To describe the occurrence and severity of pressure ulcers, indentation marks and pain from the extrication collar combined with headblocks. Furthermore, the influence of time, injury severity and patient characteristics on the development of pressure ulcers, indentation marks and pain was explored. DESIGN Observational. STUDY SETTING Level one trauma centre in the Netherlands. PARTICIPANTS Adult trauma patients admitted to the Emergency Department in an extrication collar combined with headblocks. METHODS Between January and December 2013, 342 patients were included. Study outcomes were incidence and severity of pressure ulcers, indentation marks and pain. The following dependent variables were collected: time in the cervical collar and headblocks, Glasgow Coma Scale, Mean Arterial Pressure, haemoglobin, Injury Severity Score, gender, age, and Body Mass Index. RESULTS 75.4% of the patients developed a category 1 and 2.9% a category 2 pressure ulcer. Indentation marks were observed in 221 (64.6%) patients; 96 (28.1%) had severe indentation marks. Pressure ulcers and indentation marks were observed most frequently at the back, shoulders and chest. 63.2% experienced pain, of which, 38.5% experienced severe pain. Pain was mainly located at the occiput. Female patients experienced significantly more pain (NRS>3) compared to male patients (OR=2.14, 95% CI 1.21-3.80) None of the investigated variables significantly increased the probability of developing PUs or indentation marks. CONCLUSIONS The high incidence of category 1 pressure ulcers and severe indentation marks indicate an increased risk for pressure ulcer development and may well lead to more severe PU lesions. Pain due to the application of the extrication collar and headblocks may lead to undesirable movement (in order to relieve the pressure) or to bias clinical examination of the cervical spine. It is necessary to revise the current practice of cervical spine immobilization.
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Affiliation(s)
- Wietske H W Ham
- University Medical Center Utrecht, Emergency Department, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Lisette Schoonhoven
- University of Southampton, Faculty of Health Sciences, NIHR CLAHRC, Level A, (MP11) South Academic Block, Southampton General Hospital, Tremona Road, SO16 6YD, United Kingdom; Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
| | - Marieke J Schuurmans
- University Medical Center Utrecht, Nursing Science, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Luke P H Leenen
- University Medical Center, Department of Traumatology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Lee AY, Elojeimy S, Kanal KM, Linnau KF, Gunn ML. The effect of trauma backboards on computed tomography radiation dose. Clin Radiol 2016; 71:499.e1-8. [PMID: 26932776 DOI: 10.1016/j.crad.2016.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 12/21/2015] [Accepted: 01/04/2016] [Indexed: 11/28/2022]
Abstract
AIM To assess the effect of trauma backboards on the radiation dose at computed tomography (CT) when using automatic tube current modulation (ATCM). MATERIALS AND METHODS An anthropomorphic phantom was scanned with two commercially available CT systems (GE LightSpeed16 Pro and Siemens Definition AS+) without and with backboards. Tube current-time product (mAs), and CTDIvol (mGy) were recorded for each examination. Thermoluminescent dosimeters were used to measure skin entrance dose in the pelvis and breast. Statistical significance was determined using a two-sample t-test. In addition, an institutional review board-approved retrospective image review was performed to quantify the frequency of backboard use during CT in the emergency department. RESULTS There was a statistically significant increase in maximum tube current-time product (p<0.05) and CTDIvol (p<0.05) with the presence of a backboard; tube current-time product increased up to 31% and CTDIvol increased up to 27%. There was a significant increase in skin entrance dose in the anterior and posterior pelvis (p<0.05) with the presence of a backboard; skin entrance dose increased up to 25% in the anterior pelvis. Skin entrance dose to the breast increased with a backboard, although this was not statistically significant. The frequency of backboard use during CT markedly decreased (from 77% to 3%) after instituting a multidisciplinary policy to promptly remove patients from backboards upon arrival to the emergency department after a primary clinical survey. CONCLUSIONS Using backboards during CT with ATCM can significantly increase the radiation dose. Although the decision to maintain patients on backboards is multifactorial, attempts should be made to minimise backboard use during CT when possible.
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Affiliation(s)
- A Y Lee
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 1600 Divisadero Street, San Francisco, CA 94115, USA
| | - S Elojeimy
- Department of Radiology, University of New Mexico, MSC 10-5530, Albuquerque, NM 87131, USA
| | - K M Kanal
- Department of Radiology, University of Washington, Box 359728, 325 9th Avenue, Seattle, WA 98104, USA
| | - K F Linnau
- Department of Radiology, University of Washington, Box 359728, 325 9th Avenue, Seattle, WA 98104, USA
| | - M L Gunn
- Department of Radiology, University of Washington, Box 359728, 325 9th Avenue, Seattle, WA 98104, USA.
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Oteir AO, Smith K, Stoelwinder JU, Middleton J, Jennings PA. Should suspected cervical spinal cord injury be immobilised?: a systematic review. Injury 2015; 46:528-35. [PMID: 25624270 DOI: 10.1016/j.injury.2014.12.032] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 12/21/2014] [Accepted: 12/30/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Spinal cord injuries occur worldwide; often being life-threatening with devastating long term impacts on functioning, independence, health, and quality of life. OBJECTIVES Systematic review of the literature to determine the efficacy of cervical spinal immobilisation (vs no immobilisation) in patients with suspected cervical spinal cord injury (CSCI); and to provide recommendations for prehospital spinal immobilisation. METHODS Searches were conducted of the Cochrane library, CINAHL, EMBASE, Pubmed, Scopus, Web of science, Google scholar, and OvidSP (MEDLINE, PsycINFO, and DARE) databases. Studies were included if they were relevant to the research question, published in English, based in the prehospital setting, and included adult patients with traumatic injury. RESULTS The search identified 1471 citations, of which eight observational studies of variable quality were included. Four studies were retrospective cohorts, three were case series and one a case report. Cervical collar application was reported in penetrating trauma to be associated with unadjusted increased risk of mortality in two studies [(OR, 8.82; 95% CI, 1.09-194; p=0.038) & (OR, 2.06; 95% CI, 1.35-3.13)], concealment of neck injuries in one study and increased scene time in another study. While, in blunt trauma, one study indicated that immobilisation might be associated with worsened neurological outcome (OR, 2.03; 95% CI, 1.03-3.99; p=0.04, unadjusted). We did not attempt to combine study results due to significant heterogeneity of study design and outcome measures. CONCLUSION There is a lack of high-level evidence on the effect of prehospital cervical spine immobilisation on patient outcomes. There is a clear need for large prospective studies to determine the clinical benefit of prehospital spinal immobilisation as well as to identify the subgroup of patients most likely to benefit.
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Affiliation(s)
- Ala'a O Oteir
- Department of Community Emergency Health and Paramedic Practice, Monash University Melbourne, Victoria, Australia.
| | - Karen Smith
- Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Johannes U Stoelwinder
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - James Middleton
- Rehabilitation Studies Unit, Sydney Medical School-Northern, The University of Sydney, New South Wales, Australia
| | - Paul A Jennings
- Department of Community Emergency Health and Paramedic Practice, Monash University Melbourne, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia
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Ham WH, Schoonhoven L, Schuurmans MJ, Veugelers R, Leenen LP. Pressure Ulcer Education Improves Interrater Reliability, Identification, and Classification Skills by Emergency Nurses and Physicians. J Emerg Nurs 2015; 41:43-51. [DOI: 10.1016/j.jen.2014.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 03/11/2014] [Accepted: 03/16/2014] [Indexed: 11/29/2022]
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Anderton MJ, Lovell ME. Influence of bearing devices on the dose effect and image quality of trauma whole-body CT scans. Injury 2014; 45:2111-2. [PMID: 24810666 DOI: 10.1016/j.injury.2014.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 04/06/2014] [Indexed: 02/02/2023]
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Hemmes B, Brink PRG, Poeze M. Effects of unconsciousness during spinal immobilization on tissue-interface pressures: A randomized controlled trial comparing a standard rigid spineboard with a newly developed soft-layered long spineboard. Injury 2014; 45:1741-6. [PMID: 24998039 DOI: 10.1016/j.injury.2014.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/09/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Immobilization of the spine of patients with trauma at risk of spinal damage is usually performed using a rigid long spineboard or vacuum mattress, both during prehospital and in-hospital care. However, disadvantages of these immobilization devices in terms of discomfort and tissue-interface pressures have guided the development of soft-layered long spineboards. We compared tissue-interface pressures between awake and anaesthetized (unconscious) patients during immobilization on a rigid spineboard and a soft-layered long spineboard. METHODS In this comparative study, 30 anaesthetized patients were randomized to immobilization on either the rigid spineboard or the soft-layered spineboard for the duration of their elective surgery. Tissue-interface pressures measured using an Xsensor pressure-mapping device were compared with those of 30 healthy volunteers who were immobilized sequentially on the rigid spineboard and the soft-layered spineboard. Redness of the sacrum was also recorded for the anaesthetized patients immediately after the surgery. RESULTS For both anaesthetized patients and awake volunteers, tissue-interface pressures were significantly lower on the soft-layered spineboard than on the rigid spineboard, both at start and after 15min. On the soft-layered spineboard, tissue interface pressure and peak pressure index (PPI) for the sacrum were significantly lower for anaesthetized patients than for awake volunteers. Peak pressures and PPI on the rigid spineboard were equal for both groups. Tissue-interface pressures did not change significantly over time. Redness of the sacrum was significantly more pronounced on the rigid spineboard than on the soft-layered spineboard. CONCLUSIONS This prospective randomized controlled trial shows that using a soft-layered spineboard compared to a rigid spineboard for spinal immobilization resulted in lower tissue-interface pressures in both awake volunteers and anaesthetized patients. Moreover, tissue-interface pressures on the soft-layered spineboard were lower in anaesthetized patients than in awake volunteers. These findings show the importance of using a soft-layered spineboard to reduce tissue-interface pressure, especially for patients who cannot relieve pressure themselves by changing position.
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Affiliation(s)
- Baukje Hemmes
- Network Acute Care Limburg, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Peter R G Brink
- Network Acute Care Limburg, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Traumatology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Martijn Poeze
- Network Acute Care Limburg, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Traumatology, Maastricht University Medical Center, Maastricht, The Netherlands; NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands.
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Abstract
INTRODUCTION Spinal cord injury (SCI) is a serious condition that may lead to long-term disabilities placing financial and social burden on patients and their families, as well as their communities. Spinal immobilization has been considered the standard prehospital care for suspected SCI patients. However, there is a lack of consensus on its beneficial impact on patients' outcome. OBJECTIVE This paper reviews the current literature on the epidemiology of traumatic SCI and the practice of prehospital spinal immobilization. DESIGN A search of literature was undertaken utilizing the online databases Ovid Medline, PubMed, CINAHL, and the Cochrane Library. The search included English language publications from January 2000 through November 2012. RESULTS The reported annual incidence of SCI ranges from 12.7 to 52.2 per 1 million and occurs more commonly among males than females. Motor vehicle collisions (MVCs) are the major reported causes of traumatic SCI among young and middle-aged patients, and falls are the major reported causes among patients older than 55. There is little evidence regarding the relationship between prehospital spinal immobilization and patient neurological outcomes. However, early patient transfer (8-24 hours) to spinal care units and effective resuscitation have been demonstrated to lead to better neurological outcomes. CONCLUSION This review reaffirms the need for further research to validate the advantages, disadvantages, and the effects of spinal immobilization on patients' neurological outcomes.
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White CC, Domeier RM, Millin MG. EMS spinal precautions and the use of the long backboard - resource document to the position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma. PREHOSP EMERG CARE 2014; 18:306-14. [PMID: 24559236 DOI: 10.3109/10903127.2014.884197] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Field spinal immobilization using a backboard and cervical collar has been standard practice for patients with suspected spine injury since the 1960s. The backboard has been a component of field spinal immobilization despite lack of efficacy evidence. While the backboard is a useful spinal protection tool during extrication, use of backboards is not without risk, as they have been shown to cause respiratory compromise, pain, and pressure sores. Backboards also alter a patient's physical exam, resulting in unnecessary radiographs. Because backboards present known risks, and their value in protecting the spinal cord of an injured patient remains unsubstantiated, they should only be used judiciously. The following provides a discussion of the elements of the National Association of EMS Physicians (NAEMSP) and American College of Surgeons Committee on Trauma (ACS-COT) position statement on EMS spinal precautions and the use of the long backboard. This discussion includes items where there is supporting literature and items where additional science is needed.
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Cervical spine fractures in elderly patients with hip fracture after low-level fall: an opportunity to refine prehospital spinal immobilization guidelines? Prehosp Disaster Med 2014; 29:96-9. [PMID: 24451399 DOI: 10.1017/s1049023x14000041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Conventional prehospital spine-assessment approaches based on low index of suspicion and mechanism of injury (MOI) result in the liberal application of spinal immobilization in trauma patients. A painful distracting injury (DI), such as a suspected hip fracture, historically has been a sufficient condition for immobilization, even in an elderly patient who suffers a simple fall from standing and exhibits no other risk factors for spinal injury. Because the elderly are at increased risk of hip fracture from low-level falls, and are also particularly susceptible to the discomfort and morbidity associated with immobilization, the prevalence of cervical spine (c-spine) fracture in this patient population was examined. METHODS Hospital billing records were used to identify all cases of traumatic femur fracture in Minnesota (USA) in 2010-2011. Concurrent diagnosis and external cause codes were used to estimate the prevalence of c-spine fracture by age and MOI. RESULTS Among 1,394 patients with femur fracture, 23 (1.7%) had a c-spine fracture. When the MOI was a fall from standing or sitting height and the patient age was ≥ 65, the prevalence dropped to 0.4% (2/565). The prevalence was similar when the definition of hip fracture additionally included pelvis fractures (0.5%; 11/2,441). Eight of the 11 patients with c-spine fracture had diagnosis codes indicative of criteria other than the DI that likely would have resulted in immobilization (eg, head injury and compromised mental status). CONCLUSIONS C-spine fracture is extremely rare in elderly patients who sustain hip fracture as a result of a low-level fall, and appears to be accompanied frequently by other known predictors of spinal injury besides DI. More research is needed to determine whether conservative use of spinal immobilization may be warranted in elderly patients with hip fracture after low-level falls when the only criteria for immobilization is the distracting hip injury.
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Oteir AO, Jennings PA, Smith K, Stoelwinder J. Should suspected cervical spinal cord injuries be immobilised? A systematic review protocol. Inj Prev 2013; 20:e5. [PMID: 24324194 DOI: 10.1136/injuryprev-2013-041080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cervical spinal cord injuries may result in life-threatening situations and long-term disability. Prehospital spinal immobilisation is the standard of care for patients with potential spinal cord injury (SCI). It aims to prepare patients for transport, achieve neutral spinal alignment, and reduce movement and secondary injuries in potentially unstable spines. However, there is a lack of evidence on its clinical benefits and its overall effect on patient outcomes. OBJECTIVES To identify the reported outcomes following immobilisation of suspected cervical SCI, to compare the effects of spinal immobilisation versus no immobilisation on the reported outcomes, and to provide recommendations for prehospital cervical immobilisation. DESIGN/METHODS A search of the literature will be conducted using relevant online databases. This will include all types of human studies that were published in English from the earliest record available to the first week of October 2013. One author will conduct the search and two independent authors will screen the titles and the abstracts identified by the search and critically appraise the selected papers. A third author will be available to resolve any disagreement. The findings will be reported according to Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Critical appraisal as well as the level and the strength of evidence will follow the National Health and Medical Research Council (NHMRC) guidelines. DISCUSSION Evidence-based practices should be pursued to further improve the prehospital care for suspected cervical SCI. This systematic review will contribute to the body of knowledge regarding the spinal immobilisation effects on the SCI patient's outcomes.
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Affiliation(s)
- Ala'a O Oteir
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Paul A Jennings
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia Ambulance Victoria, Melbourne, Victoria, Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Ambulance Victoria, Melbourne, Victoria, Australia Department of Emergency Medicine, University of Western Australia, Perth, Western Australia
| | - Johannes Stoelwinder
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Thai emergency nurses’ management of patients with severe traumatic brain injury: Comparison of knowledge and clinical management with best available evidence. ACTA ACUST UNITED AC 2013; 16:127-35. [DOI: 10.1016/j.aenj.2013.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/23/2013] [Accepted: 09/23/2013] [Indexed: 11/19/2022]
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Bouland AJ, Jenkins JL, Levy MJ. Assessing Attitudes toward Spinal Immobilization. J Emerg Med 2013; 45:e117-25. [DOI: 10.1016/j.jemermed.2013.03.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 07/12/2012] [Accepted: 03/28/2013] [Indexed: 10/26/2022]
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Oomens CWJ, Zenhorst W, Broek M, Hemmes B, Poeze M, Brink PRG, Bader DL. A numerical study to analyse the risk for pressure ulcer development on a spine board. Clin Biomech (Bristol, Avon) 2013; 28:736-42. [PMID: 23953331 DOI: 10.1016/j.clinbiomech.2013.07.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 06/28/2013] [Accepted: 07/02/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Spine boards are used to immobilise accident victims suspected of having spinal injury. Guidelines about the maximum time patients remain on the board are often exceeded and on occasions may lead to pressure ulcers. Etiological research has shown that two processes ultimately lead to pressure ulcers:"Ischemic damage" which takes several hours to initiate and "deformation damage" at high strains. The latter process is very quick and the first signs of cell damage are already evident within minutes. Thus in order to minimise the risk of pressure ulcer development during prolonged loading, a new soft-layered long spine board has been designed. METHODS A subject specific numerical approach has been adopted to evaluate the prototype spine board in comparison to a conventional spine board, with reference to the estimated strains in the soft tissues adjacent to the sacrum in the supine position. The model geometry is derived from magnetic resonance images of three human volunteers in an unloaded situation. The loaded images are used to "tune" the material parameters of skin, fat and muscle. The prediction of the deformed contours on the soft-layered board is used to validate the model. FINDINGS Comparison of the internal strains in muscle tissue near the spine showed that internal strains on the soft-layered board are reduced and maximum strains are considerably less than the threshold at which deformation damage is possible. By contrast, on the rigid spine board this threshold is exceeded in all cases. INTERPRETATION The prototype comfort board is able to reduce the risk for deformation damage and thus reduces the risk of developing pressure ulcers.
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Affiliation(s)
- C W J Oomens
- Biomedical Engineering Department, Eindhoven University of Technology, Eindhoven, The Netherlands.
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Cooney DR, Wallus H, Asaly M, Wojcik S. Backboard time for patients receiving spinal immobilization by emergency medical services. Int J Emerg Med 2013; 6:17. [PMID: 23786995 PMCID: PMC3691613 DOI: 10.1186/1865-1380-6-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 06/01/2013] [Indexed: 11/24/2022] Open
Abstract
Background Use of backboards as part of routine trauma care has recently come into question because of the lack of data to support their effectiveness. Multiple authors have noted the potential harm associated with backboard use, including iatrogenic pain, skin ulceration, increased use of radiographic studies, aspiration and respiratory compromise. An observational study was performed at a level 1 academic trauma center to determine the total and interval backboard times for patients arriving via emergency medical services (EMS). Findings Patients were directly observed. Transport time was recorded as an estimate of initiation of backboard use; arrival time, nurse report time and time of removal from the backboard were all recorded. National Emergency Department Overcrowding Study (NEDOCS) score, Emergency Severity Index (ESI) and demographic information were recorded for each patient encounter. Forty-six patients were followed. The mean total backboard time was 54 min (SD ±65). The mean EMS interval was 33 min (SD ±64), and the mean ED interval was 21 min (SD ±15). The ED backboard interval trended inversely to ESI (1 = 5 min, 2 = 10 min, 3 = 25 min, 4 = 26 min, 5 = 32 min). Conclusion Patients had a mean total backboard time of around an hour. The mean EMS interval was greater than the mean ED interval. Further study with a larger sample directed to establishing associated factors and to target possible reduction strategies is warranted.
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Affiliation(s)
- Derek R Cooney
- Department of Emergency Medicine, SUNY Upstate Medical University, 550 East Genesee / EMSTAT Center, Syracuse, NY, 13202, USA.
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Leenen LPH, van Hornsveld J. Overtillen van traumapatiënten. Crit Care 2011. [DOI: 10.1007/s12426-011-0053-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Berg G, Nyberg S, Harrison P, Baumchen J, Gurss E, Hennes E. Near-Infrared Spectroscopy Measurement of Sacral Tissue Oxygen Saturation in Healthy Volunteers Immobilized on Rigid Spine Boards. PREHOSP EMERG CARE 2010; 14:419-24. [DOI: 10.3109/10903127.2010.493988] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ellerton J, Tomazin I, Brugger H, Paal P. Immobilization and splinting in mountain rescue. Official Recommendations of the International Commission for Mountain Emergency Medicine, ICAR MEDCOM, Intended for Mountain Rescue First Responders, Physicians, and Rescue Organizations. High Alt Med Biol 2010; 10:337-42. [PMID: 20039814 DOI: 10.1089/ham.2009.1038] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Immobilization and splinting of fractures are essential to reduce morbidity and mortality in mountain rescue. Therefore, members of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) debated the results of a literature review carried out by the authors. Focusing on common immobilization and splinting techniques relevant to mountain rescue, a consensus document was formulated. Pain relief of appropriate speed of onset and strength should be available on scene. Spinal immobilization is recommended for all casualties that have sustained head or spine injury. The preferred method is a vacuum mattress with an appropriately sized rigid cervical collar. In such casualties, only those in an unsafe environment or with time-critical injuries should be evacuated before spinal immobilization is performed. In some casualties, the cervical spine may be cleared and a cervical collar may be omitted. In the presence of hemodynamic instability and where there is a suspicion of a fractured pelvis, an external compression splint should be applied. Splinting of a femoral shaft fracture is important to limit pain and life-threatening blood loss. If time allows, extremity fractures should be adequately splinted and, if the practitioner is skilled, a displaced fracture or joint dislocation should be reduced on scene with the use of appropriate analgesia.
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Affiliation(s)
- John Ellerton
- Mountain Rescue Council , England and Wales, Penrith, Cumbria, England.
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Reduced Tissue-Interface Pressure and Increased Comfort on a Newly Developed Soft-Layered Long Spineboard. ACTA ACUST UNITED AC 2010; 68:593-8. [DOI: 10.1097/ta.0b013e3181a5f304] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gélis A, Dupeyron A, Legros P, Benaïm C, Pelissier J, Fattal C. Pressure ulcer risk factors in persons with SCI: Part I: Acute and rehabilitation stages. Spinal Cord 2008; 47:99-107. [PMID: 18762807 DOI: 10.1038/sc.2008.107] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pressure ulcers (PUs) are a common complication following a spinal-cord injury (SCI). Good prevention requires identifying the individuals at risk for developing PUs. Risk assessment scales used nowadays were designed on pathophysiological concepts and are not SCI-specific. Recently, an epidemiological approach to PU risk factors has been proposed to design an SCI-specific assessment tool. The first results seem quite disappointing, probably because of the level of evidence of the risk factors used. OBJECTIVE To determine PU risk factors correlated to the patients with SCI, medical care management during the acute as well as in the rehabilitation and chronic stages. This first part focuses on identifying the risk factors during the acute and rehabilitation stages. MATERIALS AND METHODS Systematic review of the literature. RESULTS Six studies met our inclusion criteria. The risk factors during the acute stage of an SCI are essentially linked to care management and treatment modalities. There is insufficient evidence to make a recommendation on medical risk factors, except for low blood pressure on admission to the Emergency Room, with a moderate level of evidence. Regarding the rehabilitation stage, no study was deemed relevant. DISCUSSION AND CONCLUSIONS Additional observational studies are needed, for both the acute and rehabilitation stages, to improve this level of evidence. However, this systematic review unveiled the need for a carefully assessed t care management and the related practices, especially during the acute stage of an SCI.
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Affiliation(s)
- A Gélis
- Département de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire Caremeau, Nîmes, France.
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Del Rossi G, Horodyski MH, Conrad BP, Di Paola CP, Di Paola MJ, Rechtine GR. The 6-plus-person lift transfer technique compared with other methods of spine boarding. J Athl Train 2008; 43:6-13. [PMID: 18335007 DOI: 10.4085/1062-6050-43.1.6] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT To achieve full spinal immobilization during on-the-field management of an actual or potential spinal injury, rescuers transfer and secure patients to a long spine board. Several techniques can be used to facilitate this patient transfer. OBJECTIVE To compare spinal segment motion of cadavers during the execution of the 6-plus-person (6+) lift, lift-and-slide (LS), and logroll (LR) spine-board transfer techniques. DESIGN Crossover study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Eight medical professionals (1 woman, 7 men) with 5 to 32 years of experience were enlisted to help carry out the transfer techniques. In addition, test conditions were performed on 5 fresh cadavers (3 males, 2 females) with a mean age of 86.2 +/- 11.4 years. MAIN OUTCOMES MEASURE(S) Three-dimensional angular and linear motions initially were recorded during execution of transfer techniques, initially using cadavers with intact spines and then after C5-C6 spinal segment destabilization. The mean maximal linear displacement and angular motion obtained and calculated from the 3 trials for each test condition were included in the statistical analysis. RESULTS Flexion-extension angular motion, as well as anteroposterior and distraction-compression linear motion, did not vary between the LR and either the 6+ lift or LS. Compared with the execution of the 6+ lift and LS, the execution of the LR generated significantly more axial rotation (P = .008 and .001, respectively), more lateral flexion (P = .005 and .003, respectively), and more medial-lateral translation (P = .003 and .004, respectively). CONCLUSIONS A small amount of spinal motion is inevitable when executing spine-board transfer techniques; however, the execution of the 6+ lift or LS appears to minimize the extent of motion generated across a globally unstable spinal segment.
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Affiliation(s)
- Gianluca Del Rossi
- University of South Florida College of Medicine, 3500 E Fletcher Avenue, Suite 511, Tampa, FL 33612, USA.
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Stagg MJ, Lovell ME. A repeat audit of spinal board usage in the emergency department. Injury 2008; 39:323-6. [PMID: 17880970 DOI: 10.1016/j.injury.2007.05.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 03/01/2007] [Accepted: 05/21/2007] [Indexed: 02/02/2023]
Abstract
An audit of spinal board usage in 2002 was repeated [Malik MHA, Lovell ME. Current spinal board usage in emergency departments across the UK. Int J Care Injured 2003;34:327-9]. It is acknowledged that this device should be used for extrication and transport, with usual removal after the primary survey. This repeat audit was carried out to try and discover whether there have been changes regarding the use of spinal boards since its publication. We found improvements have been made in some areas including the removal of patients from boards with 21% now removing patients immediately (5% previously) and 58% removing patients following clearance on the lumbar and thoracic spine by a senior clinician after log roll (52% previously). In 2006, 21% (43% previously) are still leaving patients on spinal boards routinely until radiological evidence provides clearance, 45% will place patients on boards after their arrival even if they were not on one in pre-hospital management (48% previously) and the number of boards the department owns, remained similar. In house audits of usage remained largely unchanged at 22%. We recommend ongoing departmental review of practice.
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Affiliation(s)
- M J Stagg
- Education and Research Centre, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, United Kingdom.
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Early acute management in adults with spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med 2008; 31:403-79. [PMID: 18959359 PMCID: PMC2582434 DOI: 10.1043/1079-0268-31.4.408] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Burton JH, Dunn MG, Harmon NR, Hermanson TA, Bradshaw JR. A statewide, prehospital emergency medical service selective patient spine immobilization protocol. ACTA ACUST UNITED AC 2006; 61:161-7. [PMID: 16832265 DOI: 10.1097/01.ta.0000224214.72945.c4] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND To evaluate the practices and outcomes associated with a statewide, emergency medical services (EMS) protocol for trauma patient spine assessment and selective patient immobilization. METHODS An EMS spine assessment protocol was instituted on July 1, 2002 for all EMS providers in the state of Maine. Spine immobilization decisions were prospectively collected with EMS encounter data. Prehospital patient data were linked to a statewide hospital database that included all patients treated for spine fracture during the 12-month period following the spine assessment protocol implementation. Incidence of spine fractures among EMS-assessed trauma patients and the correlation between EMS spine immobilization decisions and the presence of spine fractures-stable and unstable-were the primary investigational outcomes. RESULTS There were 207,545 EMS encounters during the study period, including 31,885 transports to an emergency department for acute trauma-related illness. For this cohort, there were 12,988 (41%) patients transported with EMS spine immobilization. Linkage of EMS and hospital data revealed 154 acute spine fracture patients; 20 (13.0%) transported without EMS-reported spine immobilization interventions. This nonimmobilized group included 19 stable spine fractures and one unstable thoracic spine injury. The protocol sensitivity for immobilization of any acute spine fracture was 87.0% (95% confidence interval [CI], 81.7-92.3) with a negative predictive value of 99.9% (95% CI, 99.8-100). CONCLUSIONS The use of this statewide EMS spine assessment protocol resulted in one nonimmobilized, unstable spine fracture patient in approximately 32,000 trauma encounters. Presence of the protocol affected a decision not to immobilize greater than half of all EMS-assessed trauma patients.
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Affiliation(s)
- John H Burton
- Department of Emergency Medicine, Albany Medical College, Albany, New York 12208-3479, USA.
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Yeung JHH, Cheung NK, Graham CA, Rainer TH. Reduced time on the spinal board-effects of guidelines and education for emergency department staff. Injury 2006; 37:53-6. [PMID: 16246337 DOI: 10.1016/j.injury.2005.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Revised: 04/28/2005] [Accepted: 05/04/2005] [Indexed: 02/02/2023]
Abstract
AIM Prehospital spinal immobilisation is usually accomplished with a spinal board. Prolonged immobilisation on spinal boards in the emergency department (ED) can be detrimental. This study aimed to reduce the time spent by patients on spinal boards using a staff education program. METHODS Observational study in a trauma centre ED seeing 180,000ED attendances per year. The length of time immobilised on spinal board was recorded by the trauma nurse coordinator. Guidelines on removal of spinal boards were issued after recording period 1 (January-June 2001) and reinforced several times. The post-training period (period 2) extended from May to October 2003. Medians were compared using Mann-Whitney U-test (non-parametric data); chi-square test was used for categorical data. RESULTS There were 122 eligible patients in period 1 and 104 eligible patients in period 2. Median time to removal from the spinal board was reduced by 18.5 min from 50 to 31.5 min (Mann-Whitney U-test, p<0.0001, 95% CI for difference in medians 13-29 min). In period 1, 44 of 122 patients (36%) were removed from the spinal board before leaving the ED, compared to 78 of 104 patients (75%) in period 2 (p<0.0001, chi-square test). CONCLUSION The introduction of guidelines, reinforced by ED staff education, can significantly reduce the time patients spend on spinal boards after trauma and can increase the proportion of patients who can be removed from the board before leaving the ED.
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Affiliation(s)
- Janice H H Yeung
- Trauma and Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR
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Burton JH, Harmon NR, Dunn MG, Bradshaw JR. EMS provider findings and interventions with a statewide EMS spine-assessment protocol. PREHOSP EMERG CARE 2005; 9:303-9. [PMID: 16147480 DOI: 10.1080/10903120590962003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To describe the utilization and findings with a statewide, prehospital spine-assessment protocol for emergency medical services (EMS) providers in a rural state. METHODS The study was a prospective sample of EMS patients evaluated by prehospital providers for trauma-related injury during a one-year investigation period. Prehospital providers prospectively completed supplementary spine data-collection forms that reported patient demographics and EMS provider findings with the spine-assessment protocol. Data were analyzed using descriptive statistics. RESULTS There were 207,545 EMS encounters during the study period, including 31,885 transports for acute trauma-related illness. Prehospital providers provided spine-assessment forms for 2,220 patient encounters. Providers reported a decision to immobilize 1,301 (59%) patients. For these immobilized patients, spine protocol findings included 416 (32%) patients deemed as unreliable, 358 (28%) with distracting injury, 80 (6%) with an abnormal neurologic examination, and 709 (54%) with spine pain or tenderness. Linkage of EMS and hospital data revealed seven acute spine fracture patients among the 2,220 reported encounters, all of whom were immobilized by EMS providers. CONCLUSIONS Use of this prehospital spine-assessment protocol resulted in an EMS provider decision not to immobilize approximately 40% of EMS trauma patients. Few spine fracture patients were encountered during the investigational period, though all were immobilized.
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Affiliation(s)
- John H Burton
- Department of Emergency Medicine, Maine Medical Center, Portland 04102, USA.
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Luscombe MD, Williams JL. Comparison of a long spinal board and vacuum mattress for spinal immobilisation. Emerg Med J 2003; 20:476-8. [PMID: 12954698 PMCID: PMC1726197 DOI: 10.1136/emj.20.5.476] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study was designed to compare the stability and comfort afforded by the long spinal board (backboard) and the vacuum mattress. METHODS Nine volunteers wearing standardised clothing and rigid neck collars were secured on to a backboard and vacuum mattress using a standard strapping arrangement. An operating department table was used to tilt the volunteers from 45 degrees head up to 45 degrees head down, and additionally 45 degrees laterally. Movements of the head, sternum, and pubic symphysis (pelvis) from a fixed position were then recorded. The comfort level during the procedure was assessed using a 10 point numerical rating scale (NRS) where 1=no pain and 10=worst pain imaginable. RESULTS The mean body movements in the head up position (23.3 v 6.66 mm), head down (40.89 v 8.33mm), and lateral tilt (18.33 v 4.26mm) were significantly greater on the backboard than on the vacuum mattress (p<0.01 for all planes of movement). Using the NRS the vacuum mattress (mean score=1.88) was significantly more comfortable than the backboard (mean score=5.22) (p<0.01). CONCLUSIONS In the measured planes the vacuum mattress provides significantly superior stability and comfort than a backboard.
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Affiliation(s)
- M D Luscombe
- Department of Anaesthesia, Royal Hallamshire Hospital, Sheffield, UK.
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Porter KM, Allison KP. The UK emergency department practice for spinal board unloading. Is there conformity? Resuscitation 2003; 58:117-20. [PMID: 12867318 DOI: 10.1016/s0300-9572(03)00078-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Guidelines for the management of suspected spinal injury patients from the scene of their accident to the emergency department were published in September 1998. This study was commissioned on behalf of the Faculty of Pre-hospital Care at the Royal College of Surgeons of Edinburgh, to examine the handling of patients on spinal boards on arrival in the emergency department. METHOD In July 2000, 132 postal questionnaires were sent to the consultants of the emergency departments in the United Kingdom (UK) that receive more than 50000 patients per annum. Four simple questions related to spinal board handling were asked. RESULTS A response rate of 63.6% was achieved and analysis showed that log roll was the technique most commonly used to remove the patient from the board in 90% of cases. In 76.3% of departments this occurred as part of secondary survey although in which part of the secondary survey that this took place was less clear. CONCLUSIONS It is suggested that as the spine board is such a widely used piece of equipment, there should be some guidelines to standardise its use at the emergency department interface with pre-hospital care. We recommend that spinal board removal should be part of the completion of the primary survey.
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Affiliation(s)
- K M Porter
- University Hospital Birmingham NHS Trust-Sellyoak, Raddlebarn Road, Birmingham B296JD, UK.
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Abstract
The spinal board is widely used as a means of extrication and efficient transport during the pre-hospital phase of trauma management. A number of concerns have been raised regarding its subsequent usage once the patient arrives in the emergency department. We undertook a telephone study of 100 A+E departments in the United Kingdom to ascertain current spinal board usage. Our study demonstrated great variability in practice across the UK and a marked lack of on-going audit or defined protocols governing spinal board usage following the pre-hospital phase of trauma management.
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Affiliation(s)
- M H A Malik
- Department of Trauma and Orthopaedic Surgery, North Manchester General Hospital, 9 Woodacre, Whalley Range, UK.
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