Prehospital care of spinal injuries: a historical quest for reasoning and evidence

Abstract

Purpose

The practice of prehospital immobilization is coming under increasing scrutiny. Unravelling the historical sequence of prehospital immobilization might shed more light on this matter and help resolve the situation. Main purpose of this review is to provide an overview of the development and reasoning behind the implementation of prehospital spine immobilization.

Methods

An extensive search throughout historical literature and recent evidence based studies was conducted.

Results

The history of treating spinal injuries dates back to prehistoric times. Descriptions of prehospital spinal immobilization are more recent and span two distinct periods. First documentation of its use comes from the early 19th century, when prehospital trauma care was introduced on the battlefields of the Napoleonic wars. The advent of radiology gradually helped to clarify the underlying pathology. In recent decades, adoption of advanced trauma life support has elevated in-hospital trauma-care to an high standard. Practice of in-hospital spine immobilization in case of suspected injury has also been implemented as standard-care in prehospital setting. Evidence for and against prehospital immobilization is equally divided in recent evidence-based studies. In addition, recent studies have shown negative side-effects of immobilisation in penetrating injuries.

Conclusion

Although widely implementation of spinal immobilization to prevent spinal cord injury in both penetrating and blunt injury, it cannot be explained historically. Furthermore, there is no high-level scientific evidence to support or reject immobilisation in blunt injury. Since evidence in favour and against prehospital immobilization is equally divided, the present situation appears to have reached something of a deadlock.

Graphical abstract

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Abbreviations

ATLS:

Advanced Trauma Life Support

c-collar:

Cervical collar

CSI:

Cervical spine injury

c-spine:

Cervical spine

ETC:

European Trauma Course

NEXUS:

National Emergency X-Radiography Utilization Study

PHTLS:

Prehospital Trauma Life Support

US:

United States

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Correspondence to J. G. ten Brinke.

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ten Brinke, J.G., Groen, S.R., Dehnad, M. et al. Prehospital care of spinal injuries: a historical quest for reasoning and evidence. Eur Spine J 27, 2999–3006 (2018). https://doi.org/10.1007/s00586-018-5762-2

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Keywords

  • Spine
  • Immobilization
  • Prehospital
  • Trauma
  • Emergency