Safety of Blunt Spinal Injury Patient on Hospital Gurney

Wei-Che Lee ,Liang-Chi Kuo ,Yuan-Chia Cheng ,Chao-Wen Chen ,Yen-Ko Lin ,Tsung-Ying Lin ,Hsing-Lin Lin

doi:10.22514/sv81.052013.4

Abstract

Objectives. Restraint of patients on a spine board has been used in the past to prevent further spinal cord injury after rescue of patients from the scene of an accident. Removal from the spine board is a routine protocol in many hospitals once the patient has been cleared of spinal injury. However, the benefit of using a spine board, in light-weight motorcycle-related accident victims, has never been studied before.Materials and methods. A retrospective observational study enrolled patients who had sustained motorcycle-related acci-dents and were brought to our emergency department (ED). Patients with a Glasgow Coma Scale score lower than 15 and those who died at the ED, or had incomplete data, were excluded. The diagnosis of spinal injury was based upon clinical evaluation and was confirmed by computed tomography, magnetic resonance imaging or X-ray reports, as interpreted by a qualified radiologist. A neurological examination was performed, according to the Standard Neurological Classification of Spinal Cord Injury, directly after arrival and again before leaving the ED. Results. During the study period, from January 2007 to December 2010, 91 patients with spinal injuries who met the inclusi-on criteria, consisting of 35 male and 56 female patients with a mean age of 45.44±18.12 years, were enrolled in our study. The scores of the motor and sensory neurological exams did not show any significant change during the ED stay after being placed in a gurney without a spine board (p=0.432). Conclusions. Removal of the spine board and placement on a hospital gurney sponge is safe in alert patients whose primary examination is completed at the ED.

Highlights

Spinal cord injury is an important issue in trauma patients and immobilization is essential for most patients after suffering a traffic accident
Most of the victims in traffic accidents brought to hospitals by emergency medical technicians (EMTs), who are trained to immobilize patients as suggested by Advanced Trauma Life Support (ATLS), are placed on an extrication board or given a neck collar out of fear of causing further spinal injuries. [1,2,3] the proper time for removal of the extrication board and the efficacy of immobilization with an extrication board, as compared to those without a stabilization device, has rarely been studied, especially after patients have arrived at the hospital
According to ATLS guidelines, the extrication board should be removed as soon as spinal injury has been excluded, to prevent discomfort from the hard surface and the possibility that it may cause bedsores or increased occipital and lumbosacral pain in patients that have been lying down for a long period of time. [4,5] There is substantial literature highlighting the problems associated with the extrication board, and this device is widely accepted as being inappropriate for the transport or care of patients due to these problems

Summary

Introduction

Spinal cord injury is an important issue in trauma patients and immobilization is essential for most patients after suffering a traffic accident. [4,5] There is substantial literature highlighting the problems associated with the extrication board, and this device is widely accepted as being inappropriate for the transport or care of patients due to these problems It is questionable whether or not all patients rescued from the scene of an accident should be placed on an extrication board with a neck collar, especially in those patients without any signs of spinal injury, a rigid board does not conform to the shape of a patient’s back, and has been shown to provide support that is inferior to other methods of immobilization, such as a vacuum or other mattress. A neurological examination was performed before and after removal of the extrication board

Objectives

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Results

Conclusion