Introduction
Methods
Literature search
Inclusion and exclusion criteria
Inclusion criteria | Exclusion of criteria |
---|---|
Adults aged 16–99 years | Patients who have old spinal injuries |
All mechanisms of traumatic injuries | Children under 16 years old |
Papers published since 1990 | Patients who are known to be immunocompromised and not deemed as “healthy patients” |
Written in English only | Animal studies, in vitro, simulations in virtual reality or by computer |
Data collection process
Data extraction and synthesis
Quality assessment and statistical analysis
Statistical analysis
Results
Study selection
Study characteristics
Study | Study location | Type | Patients | GRADE quality | Main findings relevant to pre-hospital use of collars |
---|---|---|---|---|---|
Underbrink et al. [21] | Rocky Mountain | 4-year retrospective study | 5063 | High | No differences in neurologic deficit or patient disposition in the older adult patient with cervical spine trauma despite changes in spinal restriction protocols and resulting differences in immobilization devices |
Oosterwold et al. [19] | Netherlands | Retrospective observational study | 1082 | Moderate | Consensus among EMS staff on how to interpret the criterion ‘distracting injury’ was lacking. Adverse effects of spinal immobilisation were incompletely documented in pre-hospital care reports. To provide validated information on potential symptoms of SCI, a uniform EMS scoring system for motoric assessment should be developed |
Vanderlan et al. [22] | Louisiana State, USA | Retrospective observational study | 199 | Moderate | Cervical spine immobilisation was associated with an increased risk of death (p < 0.02, Odds ratio 2.77, 95% CI 1.18–6.49) |
Haut et al. [16] | USA | Retrospective observational study | 45,284 | High | Pre-hospital spine immobilisation was associated with higher mortality in penetrating trauma and should not be routinely used in every patient with penetrating trauma |
Brown et al. [14] | New York, USA | Retrospective observational study | 75,567 | High | Documented benefits of pre-hospital spinal immobilisation in patients with torso gunshot wounds remains unproven, despite the potential to interfere with emergent care in this patient population |
Hauswalk et al. [15] | Malaysia and New Mexico | Retrospective observational study | 454 | Moderate | Out-of-hospital immobilisation has little or no effect on neurologic outcome in patients with blunt spinal injuries |
Lemyze et al. [17] | Unknown | Retrospective observational study | 1 | Low | Early removal of a neck stabilisation can increase harm to patients after hanging due to raised intracranial pressure |
Lin et al. [18] | Asia | Retrospective observational study | 8633 | High | Incidence of cervical spinal injuries in the urban area lightweight motorcyclist is very low. Pre-hospital protocol for application of a cervical collar brace to people who have sustained a lightweight motorcycle accident in the urban area should be revised to avoid unnecessary restraint and possible complications |
Barkana et al. [13] | Israel | Retrospective observational study | 36 | Moderate | Life-threatening complications due to penetrating neck injury are common and may be overlooked if the neck is covered by a stabilisation device |
Risk of bias
Systematic review
Study | Yes | No | Undecided | Notes |
---|---|---|---|---|
Underbrink et al. [21] | X | No differences in neurologic deficit | ||
Oosterwold et al. [19] | X | Adverse effects of spinal immobilisation were incompletely documented | ||
Vanderlan et al. [22] | X | Increased risk of death | ||
Haut et al. [16] | X | Higher mortality in penetrating trauma and should not be used in every trauma patient | ||
Brown et al. [14] | X | Unproven risk | ||
Hauswalk et al. [15] | X | Immobilisation has little or no effect on neurologic outcome and can be deemed unnecessary | ||
Lemyze et al. [17] | X | When a patient has hung a spinal collar can increase the intracerebral pressure, so not to use them at all or if they have been used them remove them as soon as possible | ||
Lin et al. [18] | X | It needs to be revised to avoid unnecessary restraint and possible complications | ||
Barkana et al. [13] | X | If spinal collars are using for penetrating injuries of the neck this may mean neck injuries are overlooked and covered by a device and new management guidelines concerning pre-hospital stabilisation are suggested |