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Should suspected cervical spinal cord injury be immobilised?: a systematic review.
Oteir, Ala'a O; Smith, Karen; Stoelwinder, Johannes U; Middleton, James; Jennings, Paul A.
Afiliación
  • Oteir AO; Department of Community Emergency Health and Paramedic Practice, Monash University Melbourne, Victoria, Australia. Electronic address: alaa.oteir@monash.edu.
  • Smith K; 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.
  • Stoelwinder JU; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
  • Middleton J; Rehabilitation Studies Unit, Sydney Medical School-Northern, The University of Sydney, New South Wales, Australia.
  • Jennings PA; Department of Community Emergency Health and Paramedic Practice, Monash University Melbourne, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia.
Injury ; 46(4): 528-35, 2015 Apr.
Article en En | MEDLINE | ID: mdl-25624270
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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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Traumatismos de la Médula Espinal / Heridas no Penetrantes / Heridas Penetrantes / Medicina de Emergencia Basada en la Evidencia / Inmovilización Tipo de estudio: Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Aspecto: Patient_preference Límite: Humans Idioma: En Revista: Injury Año: 2015 Tipo del documento: Article Pais de publicación: Países Bajos
Texto completo
Añadir a Mi BVS
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XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Traumatismos de la Médula Espinal / Heridas no Penetrantes / Heridas Penetrantes / Medicina de Emergencia Basada en la Evidencia / Inmovilización Tipo de estudio: Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Aspecto: Patient_preference Límite: Humans Idioma: En Revista: Injury Año: 2015 Tipo del documento: Article Pais de publicación: Países Bajos