Cervical Collar
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Supportive (Green)
|
Range of motion
|
Patient
|
PH-Paramedic
|
Bäcker HC, Elias P, Braun KF, Johnson MA, Turner P, Cunningham J. Cervical immobilization in trauma patients: soft collars better than rigid collars? A systematic review and meta-analysis. Eur Spine J 2022. 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)
|
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
|
Neutral (Yellow)
|
Mortality and functional outcomes
|
Patient
|
PH-Paramedic
|
Jung E, Ro YS, Ryu HH, Shin SD. Impact of cervical spine immobilization on clinical outcomes in traumatic brain injury patients according to prehospital mean arterial pressure: A multinational and multicenter observational study. Med 2023; 102(7):e32849. Medline
|
II
|
Neutral (Yellow)
|
Mortality, in-hospital
|
Patient
|
PH-Paramedic
|
Lee SJ, Jian L, Liu CY, Tzeng IS, et al. A Ten-Year Retrospective Cohort Study on Neck Collar Immobilization in Trauma Patients with Head and Neck Injuries. Med Nov 2023; 59(11). 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)
|
Adverse effects and 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)
|
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)
|
Pain intensity related to type of cervical collar.
|
Patient
|
ED-MD
|
Baker R, Klim S, Poonian J, Ritchie P, Ng S, Kelly AM. SOFTLY: Comparison of outcomes of rigid versus soft collar during emergency department investigation for potential cervical spine injury in low-risk blunt trauma patients - A pilot study. Emerg Med Australas August 2023; 35(4):652-656. 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)
|
adverse neurological outcomes
|
Patient
|
PH-Paramedic
|
Pandor A, Essat M, Sutton A, et al. Cervical spine immobilisation following blunt trauma in pre-hospital and emergency care: A systematic review. PLoS One April 2024; 19(4):e0302127. 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)
|
Number of missed acute cervical spine injuries
|
Patient
|
PH-Paramedic
|
Vaillancourt C, Charette M, Sinclair J, et al. Implementation of the Modified Canadian C-Spine Rule by Paramedics. Ann Emerg Med 2023; 81(2):187-96. 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)
|
Use of a rule out tool
|
Process
|
PH-Paramedic & MD
|
Hofstetter P, Schröder H, Beckers SK, Borgs C, Rossaint R, Felzen M. Immobilization in Emergency Medical Service - Are CSR and NEXUS-Criteria Considered? A Matched-Pairs Analysis Between Trauma Patients Treated by Onsite EMS Physicians and Patients Treated by Tele-EMS Physicians. Open Access Emerg Med 2023; 15:145-55 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
|
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
|
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)
|
Favourable functional outcome
|
Patient
|
PH-Paramedic
|
Chen HA, Hsu ST, Shin SD, Jamaluddin SF, Son DN, Hong KJ, et al. A multicenter cohort study on the association between prehospital immobilization and functional outcome of patients following spinal injury in Asia. Sci Rep 2022; 12(1):3492. 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
|
Spinal Precautions
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Neutral (Yellow)
|
Mortality and significant disability
|
Patient
|
PH-Paramedic
|
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
|
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)
|
-
|
|
|
Kraai TW, Groen SR, Nawijn F, et al. The effect of ATLS/PHTLS spinal motion restriction protocol on the incidence of spinal cord injury, a nationwide database study. Eur Spine J Sept 2024; 33(9):3637-44. Medline
|