Click to goto CDHA Public Site Click to goto DivEMS Dal Public Site Click to goto EHS Nova Scotia

Spinal Injury

Date Last Search Run: Feb 01, 2022
Table last updated: Oct 25, 2021
Data last added: Apr 23, 2022

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)
2 (fair evidence exists)
3 (weak evidence exists)  


Interventions

Cervical Collar
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Cervical motion Process In-Patient Chandler DR., Nemejc C., Adkins RH., et al. Emergency cervical-spine immobilization. Ann Emerg Med 1992; 21(10):19-21 Medline
II Supportive (Green) Cervical motion Process SIM Podalsky S., Baraff LJ., Simon RR., Hoffman JR., Larmon B., Ablon W. Efficacy of cervical spine immobilization methods. J Trauma 1983; 23:461–5. Medline
II Neutral (Yellow) Measured (mm) cervical spine range of motion Patient SIM Hostler D., Colburn D., Seitz SR. A comparison of three cervical immobilization devices. Prehosp Emerg Care 2009; 13(2):256-60. Medline
II Opposes (Red) Intracranial pressure Process ED-MD Davies G., Deakin C., Wilson A. The effect of a rigid collar onintracranial pressure. Injury 1996; 27:647-9.47. Medline
II Opposes (Red) Occurrence and severity of pressure ulcers Patient Ham WH., Schoonhoven L., Schuurmans MJ., Leenen LP. Pressure ulcers, indentation marks and pain from cervical spine immobilization with extrication collars and headblocks: An observational study. Injury. 2016;47(9):1924-31. Medline
II Opposes (Red) Efficacy Patient PH-Paramedic Hawkridge K, Ahmed I, Ahmed Z. Evidence for the use of spinal collars in stabilising spinal injuries in the pre-hospital setting in trauma patients: A systematic review. Eur J Trauma Emerg Surg 2020. Medline
II Opposes (Red) ICP Patient PH-Paramedic Hunt K., Hallworth S., Smith M. The effects of rigid collarplacement on intracranial and cerebral perfusion pressures. Anaesthesia 2001; 56:511. Medline
II Opposes (Red) ICP Patient ED-MD Mobbs RJ., Stoodley MA., Fuller J. Effect of cervical hard col-lar on intracranial pressure after head injury. Aust N Z J Surg 2002; 72:389-91. Medline
III Supportive (Green) Cervical motion Process SIM Engsberg JR., Standeven JW., Shurtleff TL., Eggars JL., Shafer JS., Naunheim RS. Cervical spine motion during extrication. J Emerg Med 2013; 44:122–7. Medline
III Supportive (Green) Spinal movement Patient SIM Kwan I., Bunn F. Effects of prehospital spinal immobilization: A systematic review of randomized trials on healthy subjects. Prehosp Disaster Med 2005; 20(1):47-53. Medline
III Neutral (Yellow) Optimal type of immobilization, Ideal type of immobilization during AW management, morbidity of pts transported by EMS Process Ahn H., Singh J., Nathens A., MacDonald RD., Travers A., Tallon J., et al. Pre-hospital care management of a potential spinal cord injured patient: a systematic review of the literature and evidence-based guidelines. J Neurotrauma 2011; 28(8):1341-61. Medline
III Neutral (Yellow) Ascending level of spinal injury in patients with acute spinal injury Patient PH-Paramedic Burney RE., Waggoner R., Maynard FM. Stabilization of spinal injury for early transfer. J Trauma 1989; 29:1497–9. Medline
III Neutral (Yellow) Optimal position for C-spine immobilization Patient SIM De Lorenzo RA, Olson JE, Boska M, et al. Optimal positioning for cervical immobilization. Ann Emerg Med 1996; 28(3):301-8. Medline
III Neutral (Yellow) Cervical spine motion Patient SIM Del Rossi G., Heffernan TP., Horodyski M., Rechtine GR. The effectiveness of extrication collars tested during the execution ofspine-board transfer techniques. Spine J 2004; 4:619-23.23. Medline
III Neutral (Yellow) Cervical spine motion Patient SIM Dixon M., O’Halloran J., Hannigan A., et al. Confirmation of suboptimal protocols in spinal immobilisation? Emerg Med J 2015; 32(12):939-45. Medline
III Neutral (Yellow) Cervical motion Patient SIM Horodyski M., DiPaola CP., Conrad BP., Rechtine GR. Cervical col-lars are insufficient for immobilizing an unstable cervical spineinjury. J Emerg Med 2011; 41:513-9. Medline
III Neutral (Yellow) Risks and benefits Process Klein Y., Arieli I., Sagiv S., Peleg K., Ben-Galim P. Cervical spine injuries in civilian victims of explosions: Should cervical collars be used? The Journal of Trauma and Acute Care Surgery 2016; 80(6):985-8 Medline
III Neutral (Yellow) Change in measured cerebrospinal fluid pressure Patient ED-MD Kolb JC., Summers RL., Galli RL. Cervical collar-induced changes in intracranial pressure. Am J Emerg Med 1999; 17(2):135-7. Medline
III Neutral (Yellow) Mortality Patient PH-Paramedic Oteir A., Smith K., Stoelwinder J., Middleton J., Jennings A. Should suspected cervical spinal cord injury be immobilised?: A systematic review Injury. Int. J Care Injured 2015; 46:528–35. Medline
III Neutral (Yellow) Ranges of motion permitted Patient SIM Rosen PB., McSwain NE., Arate M., et al. Comparison of two new immobilization collars. Ann Emerg Med 1992; 21(10):23-5. Medline
III Neutral (Yellow) Jugular vein diameter Patient SIM Stone MB., Tubridy CM., Curran R. The effect of rigid cervicalcollars on internal jugular vein dimensions. Acad Emerg Med 2010; 17(1):100-2. Medline
III Opposes (Red) Cervical spine biomechanics Process SIM Ben-Galim P., Dreiangel N., Mattox KL., Reitman CA., Kalantar SB., Hipp JA. Extrication collars can result in abnormal separationbetween vertebrae in the presence of a dissociative injury. Jtrauma 2010; 69:447-50.21. Medline
III Opposes (Red) ICP Patient OR Raphael J., Chotai R. Effects of the cervical collar on cere-brospinal fluid pressure. Anaesthesia 1994; 49:437-9. Medline

C-Spine Clearance
Level Direction Primary Outcome Patient/Process Setting Reference
I Neutral (Yellow) Imaging rate Process ED-MD Stiell IG., Clement CM., Grimshaw J., Brison RJ., Rowe BH., Schull MJ., et al. Implementation of the Canadian C-Spine Rule: prospective 12 centre cluster randomised trial. BMJ 2009; 339:b4146. Medline
II Supportive (Green) Kappa Process PH-Paramedic Brown LH., Gough JE., Simonds WB. Can EMS providers adequately assess trauma patients for cervical spinal injury? Prehosp Emerg Care 1998; 2:33-6. Medline
II Supportive (Green) Incidence of spine fractures Process PH-Paramedic Burton JH., Harmon NR., Dunn MG., Bradshaw JR. EMS provider findings and interventions with a statewide EMS spine-assessment protocol. Prehosp Emerg Care 2005; 9(3):303-9. Medline
II Supportive (Green) Sensitivity and Specificity Patient PH-Paramedic Domeier RM., Frederiksen SM., Welch K. Prospective performance assessment of an out-of-hospital protocol for selective spine immobilization using clinical spine clearance criteria. Annals of Emergency Medicine 2005; 46(2):123-31. Medline
II Supportive (Green) Safety Patient PH-Paramedic Muhr MD., Seabrook DL., Wittwer LK. Paramedic use of a spinal injury clearance algorithm reduces spinal immobilization in the out-of-hospital setting. Prehosp Emerg Care 1999; 3:1-6. Medline
II Supportive (Green) Validation Process Tran J., Jeanmonod D., Agresti D., Hamden K., Jeanmonod RK. Prospective validation of modified NEXUS cervical spine injury criteria in low-risk elderly fall patients. The western journal of emergency medicine. 2016;17(3):252-7. Medline
II Supportive (Green) Sensitivity and Specificity Patient PH-Paramedic Vaillancourt C., Stiell IG., Beaudoin T., Maloney J., Anton AR., Bradford P., Cain E., Travers A., Stempien M., Lees M., Munkley D., Battram E., Banek J., Wells GA. Out-of-Hospital Validation of the Canadian C-Spine Rule by Paramedics. Ann Emerg Med 2009; 54(5):663-671. Medline
II Neutral (Yellow) Predictive accuracy Process ED-MD Bandiera G., Stiell IG., Wells GA., et al. The Canadian C-spine rule performs better than unstructured physician judgment. Ann Emerg Med 2003; 42(3):395-402. Medline
II Neutral (Yellow) Sensitivity and specificity of CCCR Process ED-MD Coffey F., Hewitt S., Stiell I., et al. Validation of the canadian c-spine rule in the UK emergency department setting. Emerg Med J 2011; 28(10):873-6. Medline
II Neutral (Yellow) Identification of spinal injury Patient PH-Paramedic Domeier RM., Evans RW., Swor RA., et al. The reliability of prehospital clinical evaluation for potential spinal injury is not affected by the mechanism of injury. Prehosp Emerg Care 1999; 3:332-7. Medline
II Neutral (Yellow) Sensitivity and specificity of CCCR Patient ED-MD Duane TM., Wilson SP., Mayglothling J., et al. Canadian cervical spine rule compared with computed tomography: A prospective analysis. J Trauma 2011; 71(2):352-5; discussion 355-7. Medline
II Neutral (Yellow) Kappa Process PH-Paramedic Meldon SW., Brant TA., Cydulka RK., et al. Out-of-hospital cervical spine clearance: Agreement between emergency medical technicians and emergency physicians. J Trauma: Inj, Infec and Crit Care 1998; 45(6):1058-61. Medline
II Neutral (Yellow) Sensitivity specificity Process ED-MD Rose MK., Rosal LM., Gonzalez RP., et al. Clinical clearance of the cervical spine in patients with distracting injuries: It is time to dispel the myth. J Trauma Acute Care Surg 2012; 73(2):498-502. Medline
II Neutral (Yellow) Sensitivity Process ED-MD Stiell I., Wells G., Vandemheen K., Clement C., et al. The Canadian C-Spine Rule for Radiography in Alert and Stable Trauma Patients. JAMA 2001; 286:1841-1848. Medline
II Neutral (Yellow) Clinically important C-spine injury on radiography Process ED-MD Stiell IG., Clement CM., McKnight RD., et al. The canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med 2003; 349(26):2510-2518. Medline
II Opposes (Red) Detection of fracture Process Paykin G., O'Reilly G., Ackland HM., Mitra B. The NEXUS criteria are insufficient to exclude cervical spine fractures in older blunt trauma patients. Injury. 2017;48(5):1020-1024. Medline
III Supportive (Green) Safety Patient Armstrong BP., Simpson HK., Deakin CD. Prehospital clearance of the cervical spine: does it need to be a pain in the neck? Emer Med J 2007; 24:501-3. Medline
III Supportive (Green) Utility of rule in sports-related injury Process PH-Paramedic Carmichael H, Vaillancourt C, Shrier I, Charette M, Hobden E, Stiell IG. Evaluating the paramedic application of the prehospital Canadian C-Spine Rule in sport-related injuries. CJEM 2021. Medline
III Supportive (Green) Identification of spinal injury Patient PH-Paramedic Domeier RM., Evans RW., Swor RA., et al. Prospective validation of out-of-hospital spinal clearance criteria: A preliminary report. Acad Emerg Med 1997; 4(6):643-6. Medline
III Supportive (Green) Undiagnosed frature Process ED-MD Hunter A., McGreevy J., Linden J. Pathologic C-spine fracture with low risk mechanism and normal physical exam. Am J Emerg Med 2017; 35(9) 1383.e1-2. Medline
III Supportive (Green) Kappa Patient SIM Sahni R., Menegazzi JJ., Mosesso VN. Paramedic evaluation of clinical indicators of cervical spinal injury. Prehosp Emerg Care 1997; 1(1):16-8. Medline
III Supportive (Green) Sensitivity and Specificity Patient PH-Paramedic Stroh G., Braude D. Can an Out-of-hospital Cervical Spine Clearance Protocol identify All Patients with Injuries? An Argument for Selective Immobilization. Ann Emerg Med 2001; 37(6):609-15.
III Supportive (Green) Acute C-spine abnormality identified by radiologist Patient ED-MD Tello RR., Braude D., Fullerton L., Froman P. Outcome of trauma patients immobilized by emergency department staff, but not by emergency medical services providers: A quality assurance initiative. Prehosp Emerg Care 2014; 18(4):544-549. Medline
III Neutral (Yellow) Optimal type of immobilization, Ideal type of immobilization during AW management, morbidity of pts transported by EMS Process Ahn H., Singh J., Nathens A., MacDonald RD., Travers A., Tallon J., et al. Pre-hospital care management of a potential spinal cord injured patient: a systematic review of the literature and evidence-based guidelines. J Neurotrauma 2011; 28(8):1341-61. Medline
III Neutral (Yellow) Spine fracture on hospital chart review Patient PH-Paramedic Domeier RM., Swor RA., Evans RW., Krohmer J., Hancock JB., Fales W., Frederiksen SM., Shork MA. Multicenter Prospective Validation of Prehospital Clinical Spinal Clearance Criteria. J Trauma 2002; 53:744–50. Medline
III Neutral (Yellow) Diagnostic accuracy Process ED-MD Michaleff ZA., Maher CG., Verhagen AP., Rebbeck T., Lin CW. Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: A systematic review. CMAJ 2012; 184(16):E867-76. Medline

Hypertonic Saline
Level Direction Primary Outcome Patient/Process Setting Reference

Immobilization in Penetrating Trauma
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Mortality Patient Schubl SD., Robitsek RJ., Sommerhalder C., et al. Cervical spine immobilization may be of value following firearm injury to the head and neck. Am J Emerg Med 2016; 34(4):726-9. Medline
II Opposes (Red) Mortality Patient PH-Paramedic Haut ER., Kalish BT., Efron DT., Haider AH., Stevens KA., Kieninger AN., et al. Spine immobilization in penetrating trauma: moreharm than good? J Trauma 2010; 68:115-20, discussion 20-1. Medline
III Opposes (Red) Mortality Patient PH-Paramedic Oteir A., Smith K., Stoelwinder J., Middleton J., Jennings A. Should suspected cervical spinal cord injury be immobilised?: A systematic review Injury. Int. J Care Injured 2015; 46:528–35. Medline

In-line stabilization for intubation
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Successful intubation Process ED-MD Ollerton JE., Parr MJ., Harrison K., Hanrahan B., Sugrue M. Potential cervical spine injury and difficult airway management for emergency intubation of trauma adults in the emergency department--a systematic review. Emerg Med J 2006; 23(1):3-11. Medline
I Neutral (Yellow) Success, Number of attempts Process OR Berns SD., Patel RI., Chamberlain JM. Oral intubation using a lighted stylet vs direct laryngoscopy in older children with cervical immobilization. Acad Emerg Med 1996; 3(1):34-40. Medline
II Supportive (Green) Success Process Aoi Y., Inagawa G., Hashimoto K., Tashima H., Tsuboi S., Takahata T., et al. Airway scope laryngoscopy under manual inline stabilization and cervical collar immobilization: a crossover in vivo cinefluoroscopic study. J Trauma 2011; 71(1):32-6. Medline
II Neutral (Yellow) Success, Time to airway placement Process SIM Burkey S., Jeanmonod R., Fedor P., Stromski C., Waninger KN. Evaluation of standard endotracheal intubation, assisted laryngoscopy (airtraq), and laryngeal mask airway in the management of the helmeted athlete airway: a manikin study. Clin J Sport Med 2011; 21(4):301-6. Medline
III Supportive (Green) Time to view of entry of larynx. Process SIM Aleksandrowicz D., Gaszyski T. Airway management with cervical spine immobilisation: A comparison between the macintosh laryngoscope, truview Evo2, and totaltrack VLM used by novices--A manikin study. BioMed research international. 2016;2016:1297527. Medline
III Supportive (Green) Survival Patient ED-MD Gerling MC., Davis DP., Hamilton RS., Morris GF., Vilke GM., Garfin SR., et al. Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation. Ann Emerg Med 2000; 36(4):293-300. Medline
III Supportive (Green) First past success Process ED-MD Holmes MG., Dagal A., Feinstein BA., Joffe AM. Airway Management Practice in Adults With an Unstable Cervical Spine: The Harborview Medical Center Experience. Anesth Analg 2018; 127(2):450-4. Medline
III Supportive (Green) Safety Patient ED-MD Scannel G., Waxman K., Tominaga G., et al. Orotracheal intubations in trauma patients with cervical fractures. Arch Surg 1993; 128:903-6. Medline
III Neutral (Yellow) Optimal type of immobilization, Ideal type of immobilization during AW management, morbidity of pts transported by EMS Process Ahn H., Singh J., Nathens A., MacDonald RD., Travers A., Tallon J., et al. Pre-hospital care management of a potential spinal cord injured patient: a systematic review of the literature and evidence-based guidelines. J Neurotrauma 2011; 28(8):1341-61. Medline
III Neutral (Yellow) First pass success rate Process Hodnick R., Zitek T., Galster K., Johnson S., Bledsoe B., Ebbs D. A Comparison of Paramedic First Pass Endotracheal Intubation Success Rate of the VividTrac VT-A 100, GlideScope Ranger, and Direct Laryngoscopy Under Simulated Prehospital Cervical Spinal Immobilization Conditions in a Cadaveric Model. Prehosp Disaster Med 2017:1-4. Medline
III Neutral (Yellow) Ease of ETI Process ED-MD Manoach S., Paladino L. Manual in-line stabilization for acute airway management of suspected cervical spine injury: historical review and current questions. Ann Emerg Med 2007; 50:236-45. Medline
III Neutral (Yellow) Success Process Smereka J., Ladny JR., Naylor A., Ruetzler K., Szarpak L. C-MAC compared with direct laryngoscopy for intubation in patients with cervical spine immobilization: A manikin trial. Am J Emerg Med 2017; 35(8):1142-1146. Medline
III Neutral (Yellow) C-spine extension Patient ED-MD Watts AD., Gelb AW., Bach DB., Pelz DM. Comparison of the Bullard and Macintosh laryngoscopes for endotracheal intubation of patients with a potential cervical spine injury. Anesthesiology 1997; 87(6):1335-1342. Medline
III Neutral (Yellow) Magnitude of flexion-extension movement Patient SIM Wendling AL., Tighe PJ., Conrad BP., Baslanti TO., Horodyski M., Rechtine GR. A comparison of 4 airway devices on cervical spine alignment in cadaver models of global ligamentous instability at c1-2. Anesth Analg 2013; 117(1):126-132. Medline
III Neutral (Yellow) Neuro Deterioration Patient ED-MD Wright SW., Robinson GG., Wright MB. Cervical spine injuries in blunt trauma patients requiring emergent endotracheal intubation. Am J Emerg Med 1992; 10(2):104-109. Medline

Leave Helmet in Place
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Changes with spinal alignment Patient Murray J., Rust DA. Cervical spine alignment in helmeted skiers and snowboarders with suspected head and neck injuries: Comparison of lateral C-spine radiographs before and after helmet removal and implications for ski patrol transport. Wilderness Environ Med 2017; 28(3):168-175. Medline
III Supportive (Green) Overall sagittal cervical alignment Patient SIM Swenson TM., Lauerman WC., Blanc RO., et al. Cervical spine alignment in the immobilized football player: Radiographic analysis before and after helmet removal. Am J Sports Med 1997; 25(2):226-230. Medline
III Supportive (Green) Head motion Patient PH-Paramedic Waninger KN. On-field management of potential cervical spine injury in helmeted football players: leave the helmet on! Clin J Sport Med 1998; 8(2):124-129. Medline
III Supportive (Green) Head motion Patient PH-Paramedic Waninger KN., Richards JG., Pan WT., Shay AR., Shindle MK. An evaluation of head movement in backboard-immobilized helmeted football, lacrosse, and ice hockey players. Clin J Sport Med 2001; 11(2):82-86. Medline

Long Spinal Immobilization Devices
Level Direction Primary Outcome Patient/Process Setting Reference
I Opposes (Red) Tissue interface pressure Patient OR Hemmes B., Brink PR., Poeze M. Effects of unconsciousness during spinal immobilization on tissue-interface pressures: A randomized controlled trial comparing a standard rigid spineboard with a newly developed soft-layered long spineboard. Injury 2014; 45(11):1741-6. Medline
II Supportive (Green) Cervical motion Process In-Patient Chandler DR., Nemejc C., Adkins RH., et al. Emergency cervical-spine immobilization. Ann Emerg Med 1992; 21(10):19-21 Medline
II Supportive (Green) Speed of application Process PH-Paramedic Mahshidfar B., Mofidi M., Yari AR., Mehrsorosh S. 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(5):462-5. Medline
II Neutral (Yellow) Neurologic disability Patient PH-Paramedic Hauswald M., Ong G., Tandberg D., et al. Out-of-hospital spinal immobilization: Its effect on neurologic injury. Acad Emerg Med 1998; 5(3):214-9. Medline
II Opposes (Red) Tissue hypoxia Process In-Patient Berg G., Nyberg S., Harrison P., Baumchen J., Gurss E., Hennes E. Near-infrared spectroscopy measurement of sacral tissue oxygen saturation in healthy volunteers immobilized on rigid spine boards. Prehosp Emerg Care 2010; 14:419–24. Medline
II Opposes (Red) Tissue hypoxia Patient In-Patient Linares HA., Mawson AR., Suarez E., Biundo JJ. Association between pressure sores and immobilization in the immediate post-injury period. Orthopedics 1987; 10:571–3. Medline
III Neutral (Yellow) Optimal type of immobilization, Ideal type of immobilization during AW management, morbidity of pts transported by EMS Process Ahn H., Singh J., Nathens A., MacDonald RD., Travers A., Tallon J., et al. Pre-hospital care management of a potential spinal cord injured patient: a systematic review of the literature and evidence-based guidelines. J Neurotrauma 2011; 28(8):1341-61. Medline
III Neutral (Yellow) Ascending level of spinal injury in patients with acute spinal injury Patient PH-Paramedic Burney RE., Waggoner R., Maynard FM. Stabilization of spinal injury for early transfer. J Trauma 1989; 29:1497–9. Medline
III Neutral (Yellow) Percentage of unstable thoracolumbar injury Patient Clemency BM., Bart JA., Malhotra A., Klun T., Campanella V., Lindstrom HA. Patients immobilized with a long spine board rarely have unstable thoracolumbar injuries. PEC 2016; 20(2):266-72. Medline
III Neutral (Yellow) Cervical spine motion Patient SIM Dixon M., O’Halloran J., Hannigan A., et al. Confirmation of suboptimal protocols in spinal immobilisation? Emerg Med J 2015; 32(12):939-45. Medline
III Neutral (Yellow) Cervical spine motion Patient SIM Dixon M., O’Holloran J., Cummins N. Biomechanical analysis of spinal immobilization during prehospital extrication: a proof of concept study. Prehosp Emerg Care 2013; 17:106. Medline
III Neutral (Yellow) Subject perception of immobilization Process SIM Hamilton RS., Pons PT. The efficacy and comfort of full-body vacuum splints for cervical–spine immobilization. J Emerg Med 1996; 14:553–9. Medline
III Neutral (Yellow) neurological outcome and (prevention of movement, spinal position- ing/alignment, comfort or pain, and complications Patient PH-Paramedic Hood N., Considine J. Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature. Aus Emerg Nurs J 2015; 5(18):118-37. Medline
III Neutral (Yellow) Spinal movement Patient SIM Kwan I., Bunn F. Effects of prehospital spinal immobilization: A systematic review of randomized trials on healthy subjects. Prehosp Disaster Med 2005; 20(1):47-53. Medline
III Neutral (Yellow) Lateral motion of the torso Process SIM Mezolewski P., Manix TH. The effectiveness of strapping techniques in spinal immobilization. Ann Emerg Med 1994; 23(6):1291-5. Medline
III Neutral (Yellow) Application time Process SIM Ms R, Riffelmann M, Kunze-Szikszay N, Lier M, Schmid O, Haus H, et al. Vacuum mattress or long spine board: which method of spinal stabilisation in trauma patients is more time consuming? A simulation study. Scand J Trauma Resusc Emerg Med 2021; 29(1):46. Medline
III Neutral (Yellow) Respiratory function Patient SIM Totten VY., Sugarman DB. Respiratory effects of spinal immobi-lization. Prehosp Emerg Care 1999; 3:347-52. Medline
III Neutral (Yellow) Patient Comfort Patient SIM Walton R., DeSalvo JF., Ernst AA., Shahane A. Padded vs unpadded spine board for cervical spine immobilization. Acad Emerg Med 1995; 2(8):725-728. Medline
III Opposes (Red) Pain from immobilization Patient SIM Chan D., Goldberg R., Tascone A., et al. The effect of spinal immobilization on healthy volunteers. Ann Emerg Med 1994; 23(1):48-51. Medline
III Opposes (Red) Pain from immobilization Patient SIM Chan D., Goldberg RM., Mason J., Chan L. Backboard versusmattress splint immobilization: a comparison of symptoms gen-erated. J Emerg Med 1996; 14:293-8. Medline
III Opposes (Red) Cervical motion Process SIM Engsberg JR., Standeven JW., Shurtleff TL., Eggars JL., Shafer JS., Naunheim RS. Cervical spine motion during extrication. J Emerg Med 2013; 44:122–7. Medline
III Opposes (Red) Ischemic Pain Patient PH-Paramedic Hauswald M., Hsu M., Stockoff C. Maximizing comfort and min-imizing ischemia: a comparison of four methods of spinalimmobilization. Prehosp Emerg Care 2000; 4:250-2. Medline
III Opposes (Red) Procedurally-induced discomfort/pain Patient SIM Lerner EB, Billittier AJ 4th, Moscati RM. The effects of neutral positioning with and without padding on spinal immobilization of healthy subjects. Prehosp Emerg Care. 1998 Apr-Jun;2(2):112-6. doi: 10.1080/10903129808958853. PMID: 9709329. Medline
III Opposes (Red) Incidence and severity of pain on visual analog scale Patient SIM Lerner EB., Billittier AJ., Moscati RM. The effects of neutral positioning with and without padding on spinal immobilization of healthy subjects. Prehosp Emerg Care 1998; 2:112–6. Medline
III Opposes (Red) Thoracic and Sacral Interface Pressures Patient SIM Main P., Lovell M. A review of seven support surfaces with empha-sis on their protection of the spinally injured. J Accid Emerg Med 1996; 13:34-7.56. Medline
III Opposes (Red) Sacral interface pressure Process SIM Nemunaitis G., Roach MJ., Boulet M., Nagy JA., Kaufman B., Mejia M., Hefzy MS. The Effect of a Liner on the Dispersion of Sacral Interface Pressures During Spinal Immobilization. Assistive Technology 2015; 27(1)9-17. Medline
III Opposes (Red) Pressure experienced Patient SIM 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; 33:447–50. Medline
III Opposes (Red) Lateral motion Process Wampler DA., Pineda C., Polk J., et al. The long spine board does not reduce lateral motion during transport--a randomized healthy volunteer crossover trial. Am J Emerg Med 2016; 34(4):717-21. Medline

Scoop stretcher
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Degrees of motion Process SIM Krell JM., McCoy MS., Sparto PJ., Fisher GL., Stoy WA., Hostler DP. Comparison of the Ferno scoop stretcher with the long board for spinal immobilization. Prehosp Emerg Care 2006; 10:46-51. Medline

Self Extrication
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Neurologic disability Patient PH-Paramedic Hauswald M., Ong G., Tandberg D., et al. Out-of-hospital spinal immobilization: Its effect on neurologic injury. Acad Emerg Med 1998; 5(3):214-9. Medline
III Supportive (Green) Cervical spine motion Patient SIM Dixon M., O’Halloran J., Hannigan A., et al. Confirmation of suboptimal protocols in spinal immobilisation? Emerg Med J 2015; 32(12):939-45. Medline
III Supportive (Green) Spinal motion Process SIM Gabrieli A, Nardello F, Geronazzo M, et al. Cervical Spine Motion During Vehicle Extrication of Healthy Volunteers [published online ahead of print, 2019 Dec 20]. Prehosp Emerg Care. 2019;1–9. Medline
III Neutral (Yellow) Cervical spine motion Patient SIM Dixon M., O’Holloran J., Cummins N. Biomechanical analysis of spinal immobilization during prehospital extrication: a proof of concept study. Prehosp Emerg Care 2013; 17:106. Medline
III Neutral (Yellow) Cervical motion Process SIM Engsberg JR., Standeven JW., Shurtleff TL., Eggars JL., Shafer JS., Naunheim RS. Cervical spine motion during extrication. J Emerg Med 2013; 44:122–7. Medline

Short Extrication Devices (ex: KED)
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Neurological outcomes Patient ED-MD Misasi A., Ward JG., Dong F., Ablah E., Maurer C., Haan JM. Prehospital Extrication Techniques Neurological Outcomes Associated with the Rapid Extrication Method and the Kendrick Extrication Device. Am Surg 2018; 84(2) 248-53. Medline
III Opposes (Red) Cervical spine motion Patient SIM Dixon M., O’Holloran J., Cummins N. Biomechanical analysis of spinal immobilization during prehospital extrication: a proof of concept study. Prehosp Emerg Care 2013; 17:106. Medline
III Opposes (Red) Cervical motion Process SIM Engsberg JR., Standeven JW., Shurtleff TL., Eggars JL., Shafer JS., Naunheim RS. Cervical spine motion during extrication. J Emerg Med 2013; 44:122–7. Medline

Soft collar
Level Direction Primary Outcome Patient/Process Setting Reference

Spinal Precautions
Level Direction Primary Outcome Patient/Process Setting Reference
III Neutral (Yellow) Neurological deterioration Patient PH-Paramedic McDonald NE., Curran-Sills G., Thomas RE. Outcomes and characteristics of non-immobilised, spine-injured trauma patients: a systematic review of prehospital selective immobilisation protocols. Emerg Med J 2016; 33(10):732-40. Medline
III Neutral (Yellow) Identification of fracture Process ED-MD Myers LA., Russi CS., Hankins DG., Berns KS., Zietlow SP. Efficacy and compliance of a prehospital spinal immobilization guideline. Int J Emerg Med 2009; 2(1):13-7. Medline
III Neutral (Yellow) Use of spinal precautions Process Other Underbrink L., Dalton AT., Leonard J., Bourg PW., Blackmore A., Valverde H., et al. New Immobilization Guidelines Change EMS Critical Thinking in Older Adults With Spine Trauma. PEC; 22(5) 637-44. Medline
X Not Yet Graded (White) - Clemency BM, Natalzia P, Innes J, Guarino S, Welch JV, Haghdel A, et al. A Change from a Spinal Immobilization to a Spinal Motion Restriction Protocol was Not Associated with an Increase in Disabling Spinal Cord Injuries. Prehosp Disaster Med 2021; 36(6):708–12. Medline

Steroid
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Extent of paralysis Patient ED-MD Bracken MB. Steroids for Acute Spinal Cord Injury. Cochrane Database 2012; 1:CD001046. Medline
I Supportive (Green) Motor and sensory function at 6 weeks and 6 months Patient ICU Bracken MB., Shepard MJ., Collins WF., et al. A randomized controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. New Engl J Med 1990; 322:1405-11. Medline
I Neutral (Yellow) Neuro Function Patient ED-MD Evaniew N., Belley-Coˆ te´ E., Fallah N., Noonan V., Rivers S., and Dvorak M. Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Systematic Review and Meta-Analysis. J of Neurotrauma 2015; 33:468–81. Medline
II Opposes (Red) Vented days/complications Process ICU Gerndt S., Rodriguez J., Pawlik J., et al. Consequences of high- dose steroid therapy for acute spinal cord injuries. J Trauma, Injury, Infection and Critical Care 1997; 42:279-84. Medline


[ PEP Database - Table of Contents ] [ Email: PEP@Dal.ca ]