• Trauma
• Spine Conditions Trauma

• Trauma
• Spine Conditions
• Emergency Medicine

One million spine injuries occur annually, and 2% to 3% are spinal cord injuries [Hauswald M. Emerg Med J. 2013]. For patients with suspected spinal injury, the use of spinal boards for spine immobilization confers no benefit [Oteir AO et al. Prehosp Disaster Med. 2014] and may cause harm [Goldberg W et al. Ann Emerg Med. 2001]. Christopher B. Colwell, MD, Denver Health Medical Center, Denver, Colorado, USA, reviewed the current evidence on the use of spinal boards for spinal immobilization.

Dr Colwell noted that the traditional use of spinal boards for spinal injuries is based on a set of beliefs that additional movement in people with suspected spinal injuries may exacerbate or cause injury and that immobilization can prevent further injury.

However, data used to support this dogma are not based on solid evidence. Dr Colwell highlighted the lack of evidence from randomized clinical controlled trials to support the recommendation to use backboards and cervical-collars (c-collars) for trauma patients with signs and symptoms of spinal injury made in the 1971 guidelines by the American Academy of Orthopedic Surgeons.

For patients with a penetrating trauma, such as a gunshot wound, Dr Colwell emphasized that the evidence clearly shows that spinal immobilization is harmful and doubles the mortality rate [Haut ER et al. J Trauma. 2010]. Because of the increased mortality rate due to delayed resuscitation, the American Academy of Neurological Surgeons recommended against spinal immobilization in patients with penetrating trauma [Theodore N et al. Neurosurgery. 2013]. Dr Colwell provided further evidence that spinal boards have harmful consequences, such as respiratory compromise and increased pain (Table 1).

Harm is also associated with c-collars [Ben-Galim P et al. J Trauma. 2010], and there is evidence to suggest that routine use of c-collars can be safely avoided [Sundstrøm T et al. J Neurotrauma. 2014].

For those looking for a way to safely transfer a patient from the pram to the hospital bed, research has shown that scoop stretchers can restrict motion as well as long boards [Del Rossi G et al. AmJ Emerg Med. 2010]. Evidence has demonstrated that controlled self-extrication had up to 4 times less spine movement [Dixon M et al. Emerg Med J. 2013].

Given the evidence, Dr Colwell concluded that change is needed regarding the traditional use of spinal boards for spinal immobilization and emphasized that if a medication had the same risk/benefit ratio as spinal boards, it would no longer be used.

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