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. 2024 Apr 25;19(4):e0302127.
doi: 10.1371/journal.pone.0302127. eCollection 2024.

Cervical spine immobilisation following blunt trauma in pre-hospital and emergency care: A systematic review

Abdullah Pandor  1 , Munira Essat  1 , Anthea Sutton  1 , Gordon Fuller  1 , Stuart Reid  2 , Jason E Smith  3 , Rachael Fothergill  4 , Dhushy Surendra Kumar  5 , Angelos Kolias  6 , Peter Hutchinson  6 , Gavin D Perkins  7 , Mark H Wilson  8 , Fiona Lecky  1
Affiliations

Cervical spine immobilisation following blunt trauma in pre-hospital and emergency care: A systematic review

Abdullah Pandor et al. PLoS One. .

Abstract

Objectives: To assess whether different cervical spine immobilisation strategies (full immobilisation, movement minimisation or no immobilisation), impact neurological and/or other outcomes for patients with suspected cervical spinal injury in the pre-hospital and emergency department setting.

Design: Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources: MEDLINE, EMBASE, CINAHL, Cochrane Library and two research registers were searched until September 2023.

Eligibility criteria: All comparative studies (prospective or retrospective) that examined the potential benefits and/or harms of immobilisation practices during pre-hospital and emergency care of patients with a potential cervical spine injury (pre-imaging) following blunt trauma.

Data extraction and synthesis: Two authors independently selected and extracted data. Risk of bias was appraised using the Cochrane ROBINS-I tool for non-randomised studies. Data were synthesised without meta-analysis.

Results: Six observational studies met the inclusion criteria. The methodological quality was variable, with most studies having serious or critical risk of bias. The effect of cervical spine immobilisation practices such as full immobilisation or movement minimisation during pre-hospital and emergency care did not show clear evidence of benefit for the prevention of neurological deterioration, spinal injuries and death compared with no immobilisation. However, increased pain, discomfort and anatomical complications were associated with collar application during immobilisation.

Conclusions: Despite the limited evidence, weak designs and limited generalisability, the available data suggest that pre-hospital cervical spine immobilisation (full immobilisation or movement minimisation) was of uncertain value due to the lack of demonstrable benefit and may lead to potential complications and adverse outcomes. High-quality randomised comparative studies are required to address this important question.

Trial registration: PROSPERO REGISTRATION Fiona Lecky, Abdullah Pandor, Munira Essat, Anthea Sutton, Carl Marincowitz, Gordon Fuller, Stuart Reid, Jason Smith. A systematic review of cervical spine immobilisation following blunt trauma in pre-hospital and emergency care. PROSPERO 2022 CRD42022349600 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022349600.

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Conflict of interest statement

All authors declare grant funding to their employing institutions from the United Kingdom National Institute for Health and Care Research (NIHR) Health Technology Assessment (HTA) Programme, as outlined in the funding statement. These competing interests do not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Study flow chart (adapted).
Fig 2
Fig 2. Summary of each study’s risk of bias using the ROBINS-I tool–review authors’ judgements.
Fig 3
Fig 3. Risk of bias assessment summary graph using the ROBINS-I tool—review authors’ judgements.
See this image and copyright information in PMC

References

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