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Spinal immobilisation for trauma patients

  1. Irene Kwan1,*,
  2. Frances Bunn2,
  3. Ian G Roberts3

Editorial Group: Cochrane Injuries Group

Published Online: 23 APR 2001

Assessed as up-to-date: 30 JUN 2007

DOI: 10.1002/14651858.CD002803


How to Cite

Kwan I, Bunn F, Roberts IG. Spinal immobilisation for trauma patients. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD002803. DOI: 10.1002/14651858.CD002803.

Author Information

  1. 1

    Royal College of Obstetricians & Gynaecologists, National Collaborating Centre For Women's and Children's Health, London, UK

  2. 2

    University of Hertfordshire, Centre for Research in Primary and Community Care, Hatfield, Hertfordshire, UK

  3. 3

    London School of Hygiene & Tropical Medicine, Cochrane Injuries Group, London, UK

*Irene Kwan, National Collaborating Centre For Women's and Children's Health, Royal College of Obstetricians & Gynaecologists, 2-16 Goodge Street, London, W1T2QA, UK. ikwan@ncc-wch.org.uk..

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 APR 2001

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Spinal immobilisation involves the use of a number of devices and strategies to stabilise the spinal column after injury and thus prevent spinal cord damage. The practice is widely recommended and widely used in trauma patients with suspected spinal cord injury in the pre-hospital setting.

Objectives

To quantify the effect of different methods of spinal immobilisation (including immobilisation versus no immobilisation) on mortality, neurological disability, spinal stability and adverse effects in trauma patients.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Injuries Group's specialised register, MEDLINE, EMBASE, CINAHL, PubMed, National Research Register and Zetoc. We checked reference lists of all articles and contacted experts in the field to identify eligible trials. Manufacturers of spinal immobilisation devices were also contacted for information. Searches were last updated in July 2007.

Selection criteria

Randomised controlled trials comparing spinal immobilisation strategies in trauma patients with suspected spinal cord injury. Trials in healthy volunteers were excluded.

Data collection and analysis

We independently applied eligibility criteria to trial reports and extracted data.

Main results

We found no randomised controlled trials of spinal immobilisation strategies in trauma patients.

Authors' conclusions

We did not find any randomised controlled trials that met the inclusion criteria. The effect of spinal immobilisation on mortality, neurological injury, spinal stability and adverse effects in trauma patients remains uncertain. Because airway obstruction is a major cause of preventable death in trauma patients, and spinal immobilisation, particularly of the cervical spine, can contribute to airway compromise, the possibility that immobilisation may increase mortality and morbidity cannot be excluded. Large prospective studies are needed to validate the decision criteria for spinal immobilisation in trauma patients with high risk of spinal injury. Randomised controlled trials in trauma patients are required to establish the relative effectiveness of alternative strategies for spinal immobilisation.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Spinal immobilisation for trauma patients

Spinal cord damage from injury causes long-term disability and can dramatically affect quality of life. The current practice of immobilising trauma patients before hospitalisation to prevent more damage may not always be necessary, as the likelihood of further damage is small. Means of immobilisation include holding the head in the midline, log rolling the person, the use of backboards and special mattresses, cervical collars, sandbags and straps. These can cause tissue pressure and discomfort, difficulty in swallowing and serious breathing problems.

The review authors could not find any randomised controlled trials of spinal immobilisation strategies in trauma patients. It is feasible to have trials comparing the different spinal immobilisation strategies. From studies of healthy volunteers it has been suggested that patients who are conscious, might reposition themselves to relieve the discomfort caused by immobilisation, which could theoretically worsen any existing spinal injuries.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

創傷病人的脊椎固定

脊椎固定要用到一些器材和策略來固定受傷後的脊柱,以避免脊髓的損傷。在懷疑脊髓損傷的到院前處置,這種做法普遍被推薦和廣泛用於創傷患者。

目標

對於創傷病患使用不同的脊椎固定(包括固定對照不固定)方法來量化對於死亡率,神經失能,脊椎穩定性及副作用的效果。

搜尋策略

我們檢索Cochrane Central Register of Controlled Trials (CENTRAL),the Cochrane Injuries 的專科登記資料庫,MEDLINE,EMBASE,CINAHL,PubMed,National Research Register以及Zetoc。我們檢閱所有文章的參考文獻並連絡該領域專家以確認合格的試驗。另外也連絡脊椎固定設備的廠商以獲得相關資訊。最近一次更新檢索是在2007年7月。

選擇標準

比較脊椎固定策略對脊髓可能受傷之創傷病患的隨機對照試驗。試驗排除健康的自願者。

資料收集與分析

我們分別將合格標準應用於試驗的報告並摘錄資料。

主要結論

我們沒有發現創傷病患使用脊椎固定策略的隨機對照試驗。

作者結論

我們沒有發現任何符合納入標準的隨機對照試驗。創傷病患其脊椎固定對於死亡率,神經失能,脊椎穩定度及副作用的效果仍不明確。因為氣管阻塞是預防創傷病患死亡的主要原因,而脊椎固定,特別是頸椎,可以促進氣管緩和,但也不能排除固定也許會增加死亡率和發病率的可能性。需要大量的前瞻性研究以驗證脊髓損傷高風險之創傷病患其脊椎固定的決定標準。隨機對照試驗需建立創傷病患使用其他脊椎固定策略的相對效果。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

創傷病人的脊椎固定 因為受傷造成的脊髓傷害會導致長期的失能且對生活品質有重大的影響。目前將創傷病人在到院前固定脊椎以避免更多的傷害的做法也許並不那麼必要,因為造成更嚴重傷害的可能性很小。固定的方法包括維持頭部在中線上,圓木滾動病患,使用背板及特殊的床墊,頸圈,沙袋及皮帶。這些過程可能會造成身體組織的壓力且不舒服,吞嚥困難及嚴重的呼吸問題。回顧的作者無法發現任何創傷病患使用脊椎固定策略的隨機對照試驗。比較不同脊椎固定策略的試驗是可行的。研究中健康的自願者被視為是有意識的病患,也許他們會移動姿勢以緩解因為固定所造成的不舒服,理論上它可能會使現有的脊髓傷害更加嚴重。