Should suspected cervical spinal cord injury be immobilised?: A systematic review

Research output: Contribution to journalArticleResearchpeer-review

19 Citations (Scopus)

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.
Original languageEnglish
Pages (from-to)528 - 535
Number of pages8
JournalInjury
Volume46
Issue number4
DOIs
Publication statusPublished - 2015

Cite this

@article{ca52db568677476caf6f8d0226114453,
title = "Should suspected cervical spinal cord injury be immobilised?: A systematic review",
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.",
author = "Ala'a Oteir and Smith, {Karen Louise} and Stoelwinder, {Johannes Uiltje} and James Middleton and Jennings, {Paul Andrew}",
year = "2015",
doi = "10.1016/j.injury.2014.12.032",
language = "English",
volume = "46",
pages = "528 -- 535",
journal = "Injury",
issn = "0020-1383",
publisher = "Elsevier",
number = "4",

}

Should suspected cervical spinal cord injury be immobilised?: A systematic review. / Oteir, Ala'a; Smith, Karen Louise; Stoelwinder, Johannes Uiltje; Middleton, James; Jennings, Paul Andrew.

In: Injury, Vol. 46, No. 4, 2015, p. 528 - 535.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Should suspected cervical spinal cord injury be immobilised?: A systematic review

AU - Oteir, Ala'a

AU - Smith, Karen Louise

AU - Stoelwinder, Johannes Uiltje

AU - Middleton, James

AU - Jennings, Paul Andrew

PY - 2015

Y1 - 2015

N2 - 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.

AB - 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.

UR - http://www.sciencedirect.com/science/article/pii/S0020138315000030

U2 - 10.1016/j.injury.2014.12.032

DO - 10.1016/j.injury.2014.12.032

M3 - Article

VL - 46

SP - 528

EP - 535

JO - Injury

JF - Injury

SN - 0020-1383

IS - 4

ER -