Is there a Reason for Spine Board Immobilization in the Emergency Department for Patients with a Potential Spinal Injury?

Abstract

Background:

Currently, after trauma most patients are transported to the hospital fully immobilized on a spine board. They are kept restrained to the board until full clinical and radiologic examination of the spinal column is completed. This protocol has potential detrimental effects, e. g., the development of pressure sores, and is very uncomfortable for the conscious patient. Early removal of the spine board, however, bears the chance of additional injury due to insufficient restraint of the spinal column.

Patients and Methods:

In this retrospective cohort study, a period (1999) in which policy advised prolonged spine board immobilization was compared to a period (2000) in which the patient was removed from the spine board immediately upon arrival in the emergency department. A cervical collar and in-line manual stabilization of the head were maintained throughout. The authors examined possible detrimental effects of early removal of the spine board on neurologic deficits.

All patients with proven spinal trauma were included in the study; in the first period 107 patients were seen, in the second, 90. The levels of the fractures in the first group were 29 cervical, 33 thoracic, and 45 lumbar; the second group had 36 cervical, 22 thoracic and 32 lumbar fracture-dislocations. There were ten and 13 patients from each group, respectively, with neurologic deficit upon arrival. Patients were evaluated neurologically upon arrival and again after removal of the spine board.

Results:

In both groups no detrimental changes were noted. Moreover, no adverse effects of early removal of the spine board were found.

Conclusion:

Despite methodological limitations of the study it is concluded that there is no reason for prolonged immobilization of trauma patients on a long spine board after the emergency department is reached.