Systematic Review
Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature

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Summary

Background

Spinal immobilisation has been a mainstay of trauma care for decades and is based on the premise that immobilisation will prevent further neurological compromise in patients with a spinal column injury. The aim of this systematic review was to examine the evidence related to spinal immobilisation in pre-hospital and emergency care settings.

Methods

In February 2015, we performed a systematic literature review of English language publications from 1966 to January 2015 indexed in MEDLINE and Cochrane library using the following search terms: ‘spinal injuries’ OR ‘spinal cord injuries’ AND ‘emergency treatment’ OR ‘emergency care’ OR ‘first aid’ AND immobilisation. EMBASE was searched for keywords ‘spinal injury OR ‘spinal cord injury’ OR ‘spine fracture AND ‘emergency care’ OR ‘prehospital care’.

Results

There were 47 studies meeting inclusion criteria for further review. Ten studies were case series (level of evidence IV) and there were 37 studies from which data were extrapolated from healthy volunteers, cadavers or multiple trauma patients. There were 15 studies that were supportive, 13 studies that were neutral, and 19 studies opposing spinal immobilisation.

Conclusion

There are no published high-level studies that assess the efficacy of spinal immobilisation in pre-hospital and emergency care settings. Almost all of the current evidence is related to spinal immobilisation is extrapolated data, mostly from healthy volunteers.

Section snippets

What is known

  • Spinal immobilisation is a mainstay of trauma management in pre-hospital and emergency care environments.

  • Spinal immobilisation is frequently used in pre-hospital and emergency care environments.

What this paper adds?

  • There is no high level evidence to assess the efficacy of spinal immobilisation in the pre-hospital or emergency settings.

  • There is evidence that for some patients spinal immobilisation causes harm.

  • Decisions to use spinal immobilisation should be based on careful assessment of risk vs benefit in individual patients.

Method

In February 2015, we performed a systematic literature review of English language publications from 1966 to February 2015 indexed in MEDLINE and Cochrane library using the search terms: ‘spinal injuries’ OR ‘spinal cord injuries’ AND ‘emergency treatment’ OR ‘emergency care’ OR ‘first aid’ AND immobilisation. EMBASE was searched for keywords ‘spinal injury OR ‘spinal cord injury’ OR ‘spine fracture AND ‘emergency care’ OR ‘prehospital care’. Adjacent terms for both searches were

  • ‘spin$ or cerv$

Results

There were 47 studies meeting inclusion criteria for further review. Ten studies were case series (LOE IV) and there were 37 studies from which data were extrapolated from healthy volunteers, cadavers or multiple trauma patients; extrapolated data does not have a level of evidence. There were 15 studies that were supportive of spinal immobilisation, 13 studies neutral for spinal immobilisation and 19 studies opposing spinal immobilisation (Table 2).

Discussion

The results of this systematic review yielded 47 studies examining the outcomes of spinal immobilisation in pre-hospital or emergency care settings. Overall, there were 15 studies supportive of spinal immobilisation, 13 studies neutral for spinal immobilisation and 19 studies opposing spinal immobilisation. There were no published high-level studies that assessed the efficacy of spinal immobilisation in the pre-hospital or emergency care setting and no randomised controlled trials were found.

Conclusion

There are no published high-level studies that assess the efficacy of spinal immobilisation in the pre-hospital and emergency care settings. Almost all of the current evidence related to spinal immobilisation is extrapolated data, mostly from healthy volunteers. There were no studies that showed spinal immobilisation improved neurological outcomes as all studies using neurological outcome as an endpoint were neutral due to high mortality rates from other causes (mostly gunshot wounds). Based on

Provenance and conflict of interest

Professor Julie Considine is a Deputy Editor of the Australasian Emergency Nursing Journal but had no role to play in the peer review or editorial decision-making process whatsoever, and was blinded to this process. There were no other conflicts of interest declared with this manuscript. This paper was not commissioned.

Acknowledgment

This systematic review was unfunded.

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