In this semi-structured interview, we found that nearly half of the awake trauma patients, otherwise eligible, had no memory of being immobilised. Discomfort related to immobilisation was reported in 38% of the trauma patients, while 80% felt a sense of protection related to being immobilised.
Strengths and limitations
The strengths of this study include the prospective design with a detailed questionnaire. Furthermore, we had a large participation rate and inclusion within 72 h of admission to ensure that the patients would have a valid recall of the immobilisation.
Our study also has some limitations. The study was single-centred and based on a selected population of patients suspected of having severe injuries. This may have reduced the generalizability of our findings, as it could be argued that the possible seriousness of the trauma could have overshadowed the discomfort and even have induced a sense of protection related to being immobilised. Furthermore, nearly half of the patients had no memory of being immobilised, which could be contributed to the selected trauma population.
Our direct access to a CT scanner in the trauma bay allowed for quick clarification of whether the immobilisation was still required. The duration of the immobilisation could therefore be shorter than at other facilities and thus may have affected our findings as one could imagine the reporting of discomfort, pain and pressure related to the immobilisation could increase with the time being immobilised.
We also limited our study by only including patients who were able to recall being immobilised. Even though they did not remember the immobilisation, they could have experienced discomfort or anxiety during the time being immobilised, being potential cases of denial.
Furthermore, we cannot exclude that some of the patients, with no memory of the immobilisation, later would have been able to recall the immobilisation.
In case the actual immobilisation could not be clearly determined based on the patient charts, the patients in question were asked for a description of their immobilisation if possible to ensure eligibility. This could have led to inclusion of patients who did not fulfil the inclusion criteria of being fully immobilised with a cervical collar and a spine board, although we find this risk minimal.
Furthermore, there were two protocols violations, as interviews were not conducted within the predetermined timeframe. The effect of these, if any, is thought to be marginal.
Finally, when conducting an interview there is a risk that the interviewer affects or influences the answers depending on their questioning techniques. Negative experiences could be underreported when health care personnel interview patients. Furthermore, when asking about specific topics, the examiner may influence the patient’s response and thereby provoke answers on topics they had not even thought of themselves.
One should also remember that the experiences of the immobilisation represent a snapshot present at the time of the interview, as these could fluctuate or change over time.
Spinal immobilisation is a routinely performed procedure of blunt trauma victims with suspected spinal cord injury and has been considered crucial for preventing secondary injuries such as neurological deterioration [
1,
8]. Despite spinal immobilisation being one of the most frequently performed prehospital interventions, high-level evidence demonstrating beneficial effects is lacking [
1]. Thus, a systematic review from 2016 could not identify any instances of neurological deterioration among spine injured patients not immobilised in the prehospital environment, [
9] hence the procedure primarily seems founded upon expert opinion rather than definitive evidence [
8,
10‐
12].
In contrast, there is strong evidence that the prehospital spinal immobilisation is associated with complications ranging from discomfort to significant physiological compromise [
13].
Spinal immobilisation with a neck collar may lead to airway management difficulty and therefore delay tracheal intubation or increase the risk of pulmonary aspiration [
1,
2,
5,
11,
13]. The insertion of a central venous catheter can also be much more difficult.
Furthermore, one study found that application of a cervical collar causes a significant decrease in lung capacity and spirometry parameters, [
3] but they did not examine the consequences hereof, such as whether this caused a subjective experience of dyspnoea.
Spinal stabilisation has also been associated with tissue ischemia and even an increased risk of pressure ulcers with prolonged use, [
4] as well as an increased intracranial pressure [
14‐
16].
Surprisingly, no studies seem to exist on the patient experience of spinal immobilisation after trauma. We found one study that compared different cervical collars in terms of patient comfort, but not the overall experience of being immobilised, [
15] and another study, based on healthy volunteers with no prior history of back pain, compared spinal immobilisation with a backboard to a vacuum mattress-splint with respect to the incidence of symptoms generated by the immobilisation process. After being immobilised for 30 min, they found that standard backboard immobilisation was associated with an increased incidence and severity of occipital and lumbosacral pain [
17].
The possible complications related to being immobilised were not determined in our study. There were, however, patients who experienced pressure and pain from the immobilisation, but only three patients (6%) experienced dyspnoea related to being immobilised.
Discomfort and pressure are related to being immobilised and these symptoms were more commonly detected than we anticipated. However, a sense of protection was a recurring theme in 80% of the trauma patients. The sense of protection primarily seemed to be based upon the reasoning for using the immobilisation, namely protect the spine and avoid further injury. Hence, if we move toward a more selective approach in the future, as the evidence of the beneficial effects of spinal immobilisation is lacking, we may have to take the patients current beliefs regarding spinal immobilisation into account.
As our study was based on a selective population of trauma patients, future research on patients not admitted to a level-one trauma centre could be of importance to enhance the knowledge of patient experience of spinal immobilisation after trauma.