Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-22T06:05:02.207Z Has data issue: false hasContentIssue false
  • English
  • Français

A Change from a Spinal Immobilization to a Spinal Motion Restriction Protocol was Not Associated with an Increase in Disabling Spinal Cord Injuries

Published online by Cambridge University Press:  03 November 2021

Brian M. Clemency Open the ORCID record for Brian M. Clemency [Opens in a new window] ,
Peter Natalzia Open the ORCID record for Peter Natalzia [Opens in a new window] ,
Johanna Innes ,
Sharon Guarino ,
Jacob V. Welch ,
Arsalan Haghdel ,
Ekaterina Noyes ,
Jeffery Jordan ,
Heather A. Lindstrom Open the ORCID record for Heather A. Lindstrom [Opens in a new window]  and
E. Brooke Lerner
Brian M. Clemency*
Affiliation:
Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New YorkUSA
Peter Natalzia
Affiliation:
Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New YorkUSA
Johanna Innes
Affiliation:
Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New YorkUSA
Sharon Guarino
Affiliation:
Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New YorkUSA
Jacob V. Welch
Affiliation:
Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New YorkUSA
Arsalan Haghdel
Affiliation:
Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New YorkUSA
Ekaterina Noyes
Affiliation:
Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New YorkUSA
Jeffery Jordan
Affiliation:
Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New YorkUSA
Heather A. Lindstrom
Affiliation:
Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New YorkUSA
E. Brooke Lerner
Affiliation:
Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New YorkUSA
*
Correspondence: Brian M. Clemency, DO, MBA, FACEP, FAEMS Department of Emergency Medicine Jacobs School of Medicine and Biomedical Sciences University at Buffalo 462 Grider St. Buffalo, New York14075USA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Over the past decade, Emergency Medical Service (EMS) systems decreased backboard use as they transition from spinal immobilization (SI) protocols to spinal motion restriction (SMR) protocols. Since this change, no study has examined its effect on the neurologic outcomes of patients with spine injuries.

Objectives:

The object of this study is to determine if a state-wide protocol change from an SI to an SMR protocol had an effect on the incidence of disabling spinal cord injuries.

Methods:

This was a retrospective review of patients in a single Level I trauma center before and after a change in spinal injury protocols. A two-step review of the record was used to classify spinal cord injuries as disabling or not disabling. A binary logistic regression was used to determine the effects of protocol, gender, age, level of injury, and mechanism of injury (MOI) on the incidence of significant disability from a spinal cord injury.

Results:

A total of 549 patients in the SI period and 623 patients in the SMR period were included in the analysis. In the logistic regression, the change from an SI protocol to an SMR protocol did not demonstrate a significant effect on the incidence of disabling spinal injuries (OR: 0.78; 95% CI, 0.44 - 1.36).

Conclusion:

This study did not demonstrate an increase in disabling spinal cord injuries after a shift from an SI protocol to an SMR protocol. This finding, in addition to existing literature, supports the introduction of SMR protocols and the decreased use of the backboard.

Keywords

backboardsignificant disabilityspinal immobilizationspinal motion restrictionspine injury
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 6 , December 2021 , pp. 708 - 712
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Clemency, BM, Tanski, CT, Chambers, JG, et al. Compulsory use of the backboard is associated with increased frequency of thoracolumbar imaging. Prehosp Emerg Care. 2018;22(4):506–510.CrossRefGoogle ScholarPubMed
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(2):112–116.CrossRefGoogle ScholarPubMed
Cordell, WH, Hollingsworth, JC, Olinger, ML, Stroman, SJ, Nelson, DR. Pain and tissue-interface pressures during spine-board immobilization. Ann Emerg Med. 1995;26(1):31–36.CrossRefGoogle ScholarPubMed
Totten, VY, Sugarman, DB. Respiratory effects of spinal immobilization. Prehosp Emerg Care. 1999;3(4):347–352.CrossRefGoogle ScholarPubMed
Schafermeyer, RW, Ribbeck, BM, Gaskins, J, Thomason, S, Harlan, M, Attkisson, A. Respiratory effects of spinal immobilization in children. Ann Emerg Med. 1991;20(9):1017–1019.CrossRefGoogle ScholarPubMed
Cooney, DR, Wallus, H, Asaly, M, Wojcik, S. Backboard time for patients receiving spinal immobilization by emergency medical services. Int J Emerg Med. 2013;6(1):17.CrossRefGoogle ScholarPubMed
Fischer, PE, Perina, DG, Delbridge, TR, et al. Spinal motion restriction in the trauma patient - a joint position statement. Prehosp Emerg Care. 2018;22(6):659–661.CrossRefGoogle ScholarPubMed
Castro-Marin, F, Gaither, JB, Rice, AD, et al. Prehospital protocols reducing long spinal board use are not associated with a change in incidence of spinal cord injury. Prehosp Emerg Care. 2020;24(3):401–410.CrossRefGoogle Scholar
Hauswald, M, Ong, G, Tandberg, D, Omar, Z. Out-of-hospital spinal immobilization: its effect on neurologic injury. Acad Emerg Med. 1998;5(3):214–219.CrossRefGoogle ScholarPubMed
New York State Department of Health Bureau of Emergency Medical Services and Trauma Systems. Prehospital/EMS Use of Long Spine Boards Memo. New York USA: 2015; 1–2.Google Scholar
Dixon, M, O’Halloran, J, Cummins, NM. Biomechanical analysis of spinal immobilization during prehospital extrication: a proof-of-concept study. Emerg Med J. 2014;31(9):745–749.CrossRefGoogle ScholarPubMed
Engsberg, JR, Standeven, JW, Shurtleff, TL, Eggars, JL, Shafer, JS, Naunheim, RS. Cervical spine motion during extrication. J Emerg Med. 2013;44(1):122–127.CrossRefGoogle ScholarPubMed
Dixon, M, O’Halloran, J, Hannigan, A, Keenan, S, Cummins, NM. Confirmation of suboptimal protocols in spinal immobilization? Emerg Med J. 2015;32(12):939–945.CrossRefGoogle Scholar
McDonald, N, Kriellaars, D, Weldon, E, Pryce, R. Head-neck motion in prehospital trauma patients under spinal motion restriction: a pilot study. Prehosp Emerg Care. 2021;25(1):117–124.CrossRefGoogle ScholarPubMed