Spinal Immobilization in the Trauma Room – a Survey-Based Analysis at German Level I Trauma Centers

Abstract

Background Spinal immobilization is a standard procedure in daily out-of-hospital emergency care. Homogenous recommendations concerning the immobilization of trauma patients during the first therapy in the emergency department do not exist. The aim of the current study was the analysis of the existing strategies concerning spinal immobilization in German level I trauma centers by an internet-based survey.

Materials and Methods The current study is a survey-based analysis of the current strategies concerning spinal immobilization in all 107 level I trauma centers in Germany. The internet-based survey consists of 6 items asking about immobilization in the emergency department.

Results The return rate was 47.7%. In 14 (28.6%) level I trauma centers the patients remained immobilized on the immobilization tool used by the professional emergency care providers. In 19 (38.8%) level I trauma centers the patients were transferred to a stretcher with a soft positioning mattress on it. Patient transfer to a spineboard or to a TraumaMattress was performed in 11 (22.4%) and 7 (14.3%) level I trauma centers, respectively. Trauma patients were never transferred to a vacuum mattress. Cervical spine protection was most of the time performed by a cervical collar (n = 48; 98.0%). In general, the surveyʼs participants were mainly satisfied (mean = 84/100) with the current strategy of spinal immobilization. The satisfaction was best if the spineboard is used.

Discussion Patient positioning during initial emergency therapy in the emergency department of German level I trauma centers is highly heterogenous. Besides complete full body immobilization, also the lack of any immobilization was reported by the surveyʼs participants.

Key words

resuscitation room - spine - immobilization - trauma

• References/Literatur

• 1 Destatis. Verkehr. Verkehrsunfälle. 2017; Fachserie 8, Reihe 7. Im Internet (Stand: 04.06.2019): https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Verkehrsunfaelle/Publikationen/Downloads-Verkehrsunfaelle/verkehrsunfaelle-jahr-2080700177004.pdf?__blob=publicationFile&v=4
• 2 Banerjee M, Bouillon B, Shafizadeh S. et al. Epidemiology of extremity injuries in multiple trauma patients. Injury 2013; 44: 1015-1021 doi:10.1016/j.injury.2012.12.007
• 3 Kreinest M, Gliwitzky B, Goller S. et al. Präklinische Immobilisation der Wirbelsäule – Freund oder Feind des Traumapatienten?. Notfall Rettungsmed 2016; 19: 41-47
• 4 Deutsche Gesellschaft für Unfallchirurgie. S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung 2016; AWMF-Register Nr. 012/019. Im Internet (Stand: 04.06.2019): https://www.awmf.org/uploads/tx_szleitlinien/012-019l_S3_Polytrauma_Schwerverletzten-Behandlung_2017-08.pdf
• 5 Stiell IG, Wells GA, Vandemheen KL. et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 2001; 286: 1841-1848
• 6 Hoffman JR, Mower WR, Wolfson AB. et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med 2000; 343: 94-99 doi:10.1056/nejm200007133430203
• 7 Kreinest M, Gliwitzky B, Schüler S. et al. Development of a new Emergency Medicine Spinal Immobilization Protocol for trauma patients and a test of applicability by German emergency care providers. Scand J Trauma Resusc Emerg Med 2016; 24: 71 doi:10.1186/s13049-016-0267-7
• 8 Kreinest M, Ludes L, Türk A. et al. Analysis of prehospital care and emergency room treatment of patients with acute traumatic spinal cord injury: a retrospective cohort study on the implementation of current guidelines. Spinal Cord 2017; 55: 16-19 doi:10.1038/sc.2016.84
• 9 Goutcher CM, Lochhead V. Reduction in mouth opening with semi-rigid cervical collars. Br J Anaesth 2005; 95: 344-348 doi:10.1093/bja/aei190
• 10 Hemmes B, Jeukens CR, Al-Haidari A. et al. Effect of spineboard and headblocks on the image quality of head CT scans. Emerg Radiol 2016; 23: 263-268 doi:10.1007/s10140-016-1396-z
• 11 Horodyski M, DiPaola CP, Conrad BP. et al. Cervical collars are insufficient for immobilizing an unstable cervical spine injury. J Emerg Med 2011; 41: 513-519 doi:10.1016/j.jemermed.2011.02.001
• 12 Chandler DR, Nemejc C, Adkins RH. et al. Emergency cervical-spine immobilization. Ann Emerg Med 1992; 21: 1185-1188
• 13 Johnson DR, Hauswald M, Stockhoff C. Comparison of a vacuum splint device to a rigid backboard for spinal immobilization. Am J Emerg Med 1996; 14: 369-372 doi:10.1016/s0735-6757(96)90051-0
• 14 Mahshidfar B, Mofidi M, Yari AR. et al. Long backboard versus vacuum mattress splint to immobilize whole spine in trauma victims in the field: a randomized clinical trial. Prehosp Disaster Med 2013; 28: 462-465 doi:10.1017/s1049023x13008637
• 15 Roessler M, Segref M, Schneider S. et al. Zeitbedarf für die Wirbelsäulenimmobilisation von Verletzten: Vakuummatratze vs. Spineboard. Anästh Intensivmed 2012; 53 (Suppl. 02) S33
• 16 Luscombe MD, Williams JL. Comparison of a long spinal board and vacuum mattress for spinal immobilisation. Emerg Med J 2003; 20: 476-478
• 17 Hamilton RS, Pons PT. The efficacy and comfort of full-body vacuum splints for cervical-spine immobilization. J Emerg Med 1996; 14: 553-559
• 18 Liao S, Schneider NRE, Hüttlin P. et al. Motion and dural sac compression in the upper cervical spine during the application of a cervical collar in case of unstable craniocervical junction-A study in two new cadaveric trauma models. PLoS One 2018; 13: e0195215 doi:10.1371/journal.pone.0195215
• 19 Liao S, Schneider NRE, Weilbacher F. et al. Spinal movement and dural sac compression during airway management in a cadaveric model with atlanto-occipital instability. Eur Spine J 2018; 27: 1295-1302 doi:10.1007/s00586-017-5416-9
• 20 Conrad BP, Marchese DL, Rechtine GR. et al. Motion in the unstable thoracolumbar spine when spine boarding a prone patient. J Spinal Cord Med 2012; 35: 53-57 doi:10.1179/2045772311Y.0000000045
• 21 Conrad BP, Horodyski M, Wright J. et al. Log-rolling technique producing unacceptable motion during body position changes in patients with traumatic spinal cord injury. J Neurosurg Spine 2007; 6: 540-543 doi:10.3171/spi.2007.6.6.4
• 22 Rechtine GR, Conrad BP, Bearden BG. et al. Biomechanical analysis of cervical and thoracolumbar spine motion in intact and partially and completely unstable cadaver spine models with kinetic bed therapy or traditional log roll. J Trauma 2007; 62: 383-388 doi:10.1097/01.ta.0000225924.12465.e6
• 23 Horodyski M, Conrad BP, Del Rossi G. et al. Removing a patient from the spine board: is the lift and slide safer than the log roll?. J Trauma 2011; 70: 1282-1285 doi:10.1097/TA.0b013e31820ff2bc
• 24 Boissy P, Shrier I, Brière S. et al. Effectiveness of cervical spine stabilization techniques. Clin J Sport Med 2011; 21: 80-88 doi:10.1097/JSM.0b013e31820f8ad5
• 25 Cordell WH, Hollingsworth JC, Olinger ML. et al. Pain and tissue-interface pressures during spine-board immobilization. Ann Emerg Med 1995; 26: 31-36
• 26 Cross DA, Baskerville J. Comparison of perceived pain with different immobilization techniques. Prehosp Emerg Care 2001; 5: 270-274
• 27 Berg G, Nyberg S, Harrison P. et al. Near-infrared spectroscopy measurement of sacral tissue oxygen saturation in healthy volunteers immobilized on rigid spine boards. Prehosp Emerg Care 2010; 14: 419-424 doi:10.3109/10903127.2010.493988
• 28 Sheerin F, de Frein R. The occipital and sacral pressures experienced by healthy volunteers under spinal immobilization: a trial of three surfaces. J Emerg Nurs 2007; 33: 447-450 doi:10.1016/j.jen.2006.11.004
• 29 Bauer D, Kowalski R. Effect of spinal immobilization devices on pulmonary function in the healthy, nonsmoking man. Ann Emerg Med 1988; 17: 915-918
• 30 Holla M. Value of a rigid collar in addition to head blocks: a proof of principle study. Emerg Med J 2012; 29: 104-107 doi:10.1136/emj.2010.092973
• 31 Connor D, Greaves I, Porter K. et al. Pre-hospital spinal immobilisation: an initial consensus statement. Emerg Med J 2013; 30: 1067-1069 doi:10.1136/emermed-2013-203207
• 32 Perry SD, McLellan B, McIlroy WE. et al. The efficacy of head immobilization techniques during simulated vehicle motion. Spine (Phila Pa 1976) 1999; 24: 1839-1844
• 33 Schou J, Kiermayer H, Ummenhofer W. et al. In search of the most suitable technique for truncal spinal immobilization with associated radiography. Eur J Emerg Med 2001; 8: 89-92
• 34 Linsenmaier U, Krotz M, Kanz KG. et al. [Evaluation of spine boards for X-Ray diagnostics]. Rofo 2001; 173: 1041-1047 doi:10.1055/s-2001-18311
• 35 Euler A, Stieltjes B, Schindera ST. Automatic tube current modulation for whole-body polytrauma CT with immobilization devices: is there an increase in radiation dose and degradation of image quality?. Emerg Radiol 2017; 24: 31-37 doi:10.1007/s10140-016-1442-x
• 36 Davies G, Deakin C, Wilson A. The effect of a rigid collar on intracranial pressure. Injury 1996; 27: 647-649
• 37 Kolb JC, Summers RL, Galli RL. Cervical collar-induced changes in intracranial pressure. Am J Emerg Med 1999; 17: 135-137