Medical Student Dell Medical School at The University of Texas at Austin Austin, Texas, United States
Introduction: Cervical spine (c-spine) stabilization has become standard practice in prehospital trauma care since being protocolized for EMS providers in the 1960s. Recent literature suggests cervical collars (c-collars) provide limited clinical value in blunt trauma and none in isolated penetrating trauma. This study aims to assess the change in frequency of c-spine immobilization in trauma patients over time.
Methods: We performed a retrospective chart review of adult trauma patients transported by EMS to our ACS verified Level 1 trauma center from 2014 to 2021. EMS documentation was manually reviewed, recording prehospital physiology and application c-collars. C-spine injuries were defined as cervical vertebral fractures and/or spinal cord injuries. Patients with and without c-spine injuries were compared in univariate analysis, and year-by-year trend analysis analyzed changes in frequency of cervical spine injury and immobilization over time.
Results: 2653 patients met inclusion criteria, of which 12% sustained c-spine injuries. Patients with c-spine injuries experienced more blunt trauma (95% vs 64%, p< 0.001), were older (46 vs 41, p< 0.001), and had higher ISS (32 vs 19, p< 0.001). Patients with c-spine injuries had lower prehospital systolic blood pressures (108 vs 121, p< 0.001), heart rates (90 vs 97, p< 0.001), and GCS (9 vs 11, p< 0.001). C-collars were applied to 83% of patients with c-spine injury and 52% of patients without. The proportion of patients with no c-spine injury and no c-collar application increased in both penetrating and blunt cohorts over time (blunt: 19% in 2014 to 37% in 2021; penetrating: 76% in 2014 to 90% in 2021). Among penetrating trauma with c-spine injury, all patients either arrived quadriplegic or did not require neurosurgical intervention. In blunt trauma, the proportion of patients with c-spine injury who received c-collars decreased over time (88% in 2014 to 73% in 2021).
Conclusion : Despite improvement in appropriate c-collar use, c-collars are still being applied to patients who do not need them and not applied to patients who would benefit. There continues to be opportunity to refine current guidelines and protocols.
How to Improve Patient Care: We investigated current use of cervical collars in prehospital trauma patients, identifying ways to better optimize protocols for cervical spine stabilization.
