“Keep them still! Don’t
let them move… if they turn their head an inch, they’ll be paralysed.”
-Dr Longheld Dogma
Protection of the cervical spine has been a bedrock of trauma care. This has
traditionally been accomplished by strapping patients to backboards and the application
of properly fitted cervical collars.
But these collars are uncomfortable, have potential harms
and can make cooperative patients rather uncooperative.
Of course we can rest easy in the knowledge that the original randomised controlled trials (RCT's) of the
cervical collar took this all into account.
What…there is no good
quality evidence that the c-collars do anything?!?
Surely there must at least be a large body of observational
literature to suggest they work? Heck, we’ve been using them for decades!
These authors sought to definitively answer the latter
question.
They conducted a thorough literature review to find cases of
neurologic deterioration in the early care of blunt spinal trauma.
In the end, they found only 41 cases from 12 papers. The quality of the evidence was “extremely
low.” They conclude the following:
No reports were found of sudden, movement-provoked deterioration during
the prehospital interval; this remains an unpublished phenomenon if not a
medical myth. Overall, since many of these events described are consistent with
the natural history of disease, it is unclear how often deterioration may be
causally linked with patient movement and furthermore whether such events are
preventable by motion restriction.
On the flip side, one might argue that lack of evidence does
not equate to lack of efficacy. After all, these collars have not truly been
studied. In addition, there may have been negative reporting bias of bad
outcomes.
What should we conclude? I think you can make up your own
mind… hopefully not while strapped to a collar.
Covering:
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