The definite risks and questionable benefits of liberal pre-hospital spinal immobilisation.
BACKGROUND
The routine practice of pre-hospital spinal immobilisation (phSI) for patients with suspected spinal injury has existed for decades. However, the controversy surrounding it resulted in the 2013 publication of a Consensus document by the Faculty of Pre-Hospital Care. The question remains as to whether the quality of evidence in the literature is sufficient to support the Consensus guidelines. This critical review aims to determine the validity of current recommendations by balancing the potential benefits and side effects of phSI.


METHODS
A review of the literature was carried out by two independent assessors using Medline, PubMed, EMBASE and the Cochrane Library databases. Manual searches of related journals and reference lists were also completed. The selected body of evidence was subsequently appraised using a checklist derived from SIGN and CASP guidelines, as well as Crombie's guide to critical appraisal.


RESULTS
No reliable sources were found proving the benefit for patient immobilisation. In contrast there is strong evidence to show that pre-hospital spinal immobilisation is not benign with recognised complications ranging from discomfort to significant physiological compromise. The published literature supports the Consensus guideline recommendations for safely reducing the impact of these side effects without compromising the patient.


CONCLUSIONS
The literature supports the Consensus Guidelines but raises the question as to whether they go far enough as there is strong evidence to suggest phSI is an inherently harmful procedure without having any proven benefit. These results demonstrate an urgent need for further studies to determine its treatment effect.
St Andrews University, Scotland, United Kingdom. Electronic address: tapurvis.22@hotmail.com.
Thomas Adam
TA
Purvis
Pre-hospital Care, Royal College of Surgeons of Ireland, Dublin, Ireland.
Brian
B
Carlin
School of Medicine, St Andrews University, St Andrews, Scotland, United Kingdom.
Peter
P
Driscoll
D004632:Emergency Medical Services / Q000592:standards*; D006801:Humans; D007103:Immobilization / Q000009:adverse effects*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000628:therapy*; D013124:Spinal Injuries / Q000175:diagnosis / Q000628:therapy*
Emergency medical services; Immobilisation; Spinal cord injuries; Spinal injuries