Spinal immobilisation for trauma patients.
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.


OBJECTIVE
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.


METHODS
We searched the Cochrane Controlled Trial Register (CCTR), the specialised register of the Cochrane Injuries Group, MEDLINE, EMBASE, CINAHL, PubMed and the National Research Register. 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.


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


METHODS
Two reviewers independently applied eligibility criteria to trial reports and extracted data.


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


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.
Kwan
I
I
Department of Paediatric Epidemiology and Biostatistics, Institute of Child Health, 30 Guilford Street, London, UK, WC1N 1EH. i.kwan@ich.ucl.ac.uk
Bunn
F
F
Roberts
I
I
D006801:Humans; D007103:Immobilization; D013119:Spinal Cord Injuries; D013124:Spinal Injuries / Q000150:complications*