title: Does turning trauma patients with an unstable spinal injury from the supine to a lateral position increase the risk of neurological deterioration?--A systematic review.
abstract: BACKGROUND
  Airway protection and spinal precautions are competing concerns in the treatment of unconscious trauma patients. The placement of such patients in a lateral position may facilitate the acquisition of an adequate airway. However, trauma dogma dictates that patients should be transported in the supine position to minimize spinal movement. In this systematic review, we sought to answer the following question: Given an existing spinal injury, will changing a patient's position from supine to lateral increase the risk of neurological deterioration?
  
  
  METHODS
  The review protocol was published in the PROSPERO database (Reg. no. CRD42012001190). We performed literature searches in PubMed, Medline, EMBASE, the Cochrane Library, CINAHL and the British Nursing Index and included studies of traumatic spinal injury, lateral positioning and neurological deterioration. The search was updated prior to submission. Two researchers independently completed each step in the review process.
  
  
  RESULTS
  We identified 1,164 publications. However, none of these publications reported mortality or neurological deterioration with lateral positioning as an outcome measure. Twelve studies used movement of the injured spine with lateral positioning as an outcome measure; eleven of these investigations were cadaver studies. All of these cadaver studies reported spinal movement during lateral positioning. The only identified human study included eighteen patients with thoracic or lumbar spinal fractures; according to the study authors, the logrolling technique did not result in any neurological deterioration among these patients.
  
  
  CONCLUSIONS
  We identified no clinical studies demonstrating that rotating trauma patients from the supine position to a lateral position affects mortality or causes neurological deterioration. However, in various cadaver models, this type of rotation did produce statistically significant displacements of the injured spine. The clinical significance of these cadaver-based observations remains unclear. The present evidence for harm in rotating trauma patients from the supine position to a lateral position, including the logroll maneuver, is inconclusive.
authors.affiliation: Norwegian Air Ambulance Foundation, Department of Research and Development, Drøbak, Norway. pkh@sshf.no.|Department of Anesthesiology and Intensive Care, Sørlandet Hospital, Kristiansand, Norway. pkh@sshf.no.
authors.forename: Per Kristian
authors.initials: PK
authors.lastname: Hyldmo
authors.affiliation: The Norwegian Knowledge Center for the Health Services, Oslo, Norway. gunn.elisabeth.vist@kunnskapssenteret.no.
authors.forename: Gunn E
authors.initials: GE
authors.lastname: Vist
authors.affiliation: Department of Anesthesiology, Oslo University Hospital, Oslo, Norway. anders.feyling@gmail.com.
authors.forename: Anders Christian
authors.initials: AC
authors.lastname: Feyling
authors.affiliation: Pre-hospital Critical Care Services, Aarhus, Denmark. leifrogn@rm.dk.
authors.forename: Leif
authors.initials: L
authors.lastname: Rognås
authors.affiliation: Department of Anesthesiology, Landspitalinn University Hospital, Reykjavík, Iceland. vidar.magnusson@gmail.com.
authors.forename: Vidar
authors.initials: V
authors.lastname: Magnusson
authors.affiliation: Faculty of Medicine, University of Oslo, Oslo, Norway. marten.sandberg@medisin.uio.no.|Air Ambulance Department, Oslo University Hospital, Oslo, Norway. marten.sandberg@medisin.uio.no.
authors.forename: Mårten
authors.initials: M
authors.lastname: Sandberg
authors.affiliation: Network for Medical Sciences, University of Stavanger, Stavanger, Norway. eldar.soreide@sus.no.|Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway. eldar.soreide@sus.no.
authors.forename: Eldar
authors.initials: E
authors.lastname: Søreide
mesh_terms: D000402:Airway Obstruction / Q000517:prevention & control; D004632:Emergency Medical Services; D006801:Humans; D056888:Patient Positioning / Q000009:adverse effects*; D013124:Spinal Injuries / Q000503:physiopathology* / Q000628:therapy*; D016683:Supine Position; D014187:Transportation of Patients; D014474:Unconsciousness