title: Should suspected cervical spinal cord injury be immobilised?: a systematic review.
abstract: BACKGROUND
  Spinal cord injuries occur worldwide; often being life-threatening with devastating long term impacts on functioning, independence, health, and quality of life.
  
  
  OBJECTIVE
  Systematic review of the literature to determine the efficacy of cervical spinal immobilisation (vs no immobilisation) in patients with suspected cervical spinal cord injury (CSCI); and to provide recommendations for prehospital spinal immobilisation.
  
  
  METHODS
  Searches were conducted of the Cochrane library, CINAHL, EMBASE, Pubmed, Scopus, Web of science, Google scholar, and OvidSP (MEDLINE, PsycINFO, and DARE) databases. Studies were included if they were relevant to the research question, published in English, based in the prehospital setting, and included adult patients with traumatic injury.
  
  
  RESULTS
  The search identified 1471 citations, of which eight observational studies of variable quality were included. Four studies were retrospective cohorts, three were case series and one a case report. Cervical collar application was reported in penetrating trauma to be associated with unadjusted increased risk of mortality in two studies [(OR, 8.82; 95% CI, 1.09-194; p=0.038) & (OR, 2.06; 95% CI, 1.35-3.13)], concealment of neck injuries in one study and increased scene time in another study. While, in blunt trauma, one study indicated that immobilisation might be associated with worsened neurological outcome (OR, 2.03; 95% CI, 1.03-3.99; p=0.04, unadjusted). We did not attempt to combine study results due to significant heterogeneity of study design and outcome measures.
  
  
  CONCLUSIONS
  There is a lack of high-level evidence on the effect of prehospital cervical spine immobilisation on patient outcomes. There is a clear need for large prospective studies to determine the clinical benefit of prehospital spinal immobilisation as well as to identify the subgroup of patients most likely to benefit.
authors.affiliation: Department of Community Emergency Health and Paramedic Practice, Monash University Melbourne, Victoria, Australia. Electronic address: alaa.oteir@monash.edu.
authors.forename: Ala'a O
authors.initials: AO
authors.lastname: Oteir
authors.affiliation: Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Johannes U
authors.initials: JU
authors.lastname: Stoelwinder
authors.affiliation: Rehabilitation Studies Unit, Sydney Medical School-Northern, The University of Sydney, New South Wales, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Middleton
authors.affiliation: Department of Community Emergency Health and Paramedic Practice, Monash University Melbourne, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Jennings
mesh_terms: D003657:Decision Making; D004632:Emergency Medical Services; D055416:Evidence-Based Emergency Medicine / Q000379:methods*; D006801:Humans; D007103:Immobilization / Q000009:adverse effects / Q000379:methods; D064887:Observational Studies as Topic; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011788:Quality of Life; D018570:Risk Assessment; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D014950:Wounds, Penetrating / Q000150:complications / Q000503:physiopathology / Q000628:therapy*
keywords: Emergency medical services; Immobilisation; Patient outcome; Prehospital emergency care; Spinal cord injuries; Spinal immobilisation; Traumatic injuries