New clinical guidelines on the spinal stabilisation of adult trauma patients \u2013 consensus and evidence based

Christian Maschmann,Monika Afzali Rubin,Elisabeth Jeppesen,Charlotte Barfod

doi:10.1186/s13049-019-0655-x

Abstract

Traumatic spinal cord injury is a relatively rare injury in Denmark but may result in serious neurological consequences. For decades, prehospital spinal stabilisation with a rigid cervical collar and a hard backboard has been considered to be the most appropriate procedure to prevent secondary spinal cord injuries during patient transportation. However, the procedure has been questioned in recent years, due to the lack of high-quality studies supporting its efficacy. A national interdisciplinary task force was therefore established to provide updated clinical guidelines on prehospital procedures for spinal stabilisation of adult trauma patients in Denmark. The guidelines are based on a systematic review of the literature and grading of the evidence, in addition to a standardised consensus process.This process yielded five main recommendations:A strong recommendation against spinal stabilisation of patients with isolated penetrating trauma; a weak recommendation against the prehospital use of a rigid cervical collar and a hard backboard for ABCDE-stable patients; and a weak recommendation for the use of a vacuum mattress for patient transportation. Finally, our group recommends the use of our clinical algorithm to ensure good clinical practice.

Highlights

Traumatic spinal cord injury (TSCI) is a relatively rare injury
In order to prevent secondary spinal cord injuries under transportation and medical treatment of trauma patients, it was postulated in the mid-1960s, that this risk might be reduced by stabilisation of the patient using a rigid cervical collar and a hard backboard
In order to involve all relevant stakeholders, an interdisciplinary working group was established consisting of representatives from eight different Medical Associations in Denmark, representatives from the Danish ATLS, PHTLS and International Trauma Life Support (ITLS) chapters, medical directors from the four largest Danish ambulance providers as well as representatives from all five Danish Emergency Medical Services (EMS) (Table 1)

Summary

Introduction

Traumatic spinal cord injury (TSCI) is a relatively rare injury. The overall annual incidence in Denmark during 1990–94 to 2010–12 was 10.2 per million person-years at risk and varied from 8.3 to 11.8 [1]. In order to prevent secondary spinal cord injuries under transportation and medical treatment of trauma patients, it was postulated in the mid-1960s, that this risk might be reduced by stabilisation of the patient using a rigid cervical collar and a hard backboard. This strategy was adopted by many prehospital medical services worldwide as well as on trauma courses such as Prehospital Trauma Life Support (PHTLS®) and Advanced Trauma Life. Support (ATLS®) [2, 3] This change occurred despite a lack of high-quality study data to suggest clear benefits [4,5,6].

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Conclusion