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Citation
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Muzyka L, Bradford JM, Teixeira PG, Dubose J, Cardenas TCP, Bach M, Ali S, Robert M, Brown CVR. Acad. Emerg. Med. 2023; ePub(ePub): ePub. |
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Abstract
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OBJECTIVE: This study aims to assess the change in cervical spine (c-spine) immobilization frequency in trauma patients over time. We hypothesize that the frequency of unnecessary c-spine immobilization has decreased.
METHODS: A retrospective chart review of adult trauma patients transported to our ACS verified Level 1 trauma center from January 1, 2014, to December 31, 2021, was performed. EMS documentation was manually reviewed to record prehospital physiology and the application of a prehospital c-collar. C-spine injuries were defined as cervical vertebral fractures and/or spinal cord injuries. Univariate and year-by-year trend analyses were used to assess changes in c-spine injury and immobilization frequency.
RESULTS: Among 2,906 patients meeting inclusion criteria, 12% sustained c-spine injuries, while 88% did not. Patients with c-spine injuries were more likely to experience blunt trauma (95% vs. 68%, p<0.001), were older (46 vs. 41, p<0.001), and had higher ISS (31 vs. 18, p<0.001). They also exhibited lower initial systolic blood pressures (108 vs. 119, p<0.001), lower heart rates (92 vs. 97, p<0.05), and lower GCS scores (9 vs. 11, p<0.001). In blunt trauma, c-collars were applied to 83% of patients with c-spine injuries and 75% without; for penetrating trauma, c-collars were applied to 50% of patients with c-spine injuries and only 8% without. Among penetrating trauma patients with c-spine injury, all patients either arrived quadriplegic or did not require emergent neurosurgical intervention. The proportion of patients receiving a c-collar decreased in both blunt and penetrating traumas from 2014 to 2021 (blunt: 82% in 2014 to 68% in 2021; penetrating: 24% in 2014 to 6% in 2021).
CONCLUSION: Unnecessary c-spine stabilization has decreased from 2014 to 2021. However, c-collars are still being applied to patients who do not need them, both in blunt and penetrating trauma cases, while not being applied to patients who would benefit from them.
Language: en |