Lack of Association between Cervical Spine Injuries and Prehospital Immobilization: From Tradition to Evidence
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. IDF Medical Teams
2.3. Cervical Injury CPGs
2.4. Data Collection
2.5. Statistical Analysis
3. Results
3.1. Patient and Injury Characteristics
3.2. Cervical Collar Use and Cervical Spine Injuries
3.3. Prehospital Treatment and Factors Associated with Cervical Collar Use
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Collar (N = 87) | No Collar (N = 133) | p-Value | |
---|---|---|---|
Patient Demographics | |||
Age | 0.537 | ||
Mean (SD) | 32.43 (15.90) | 31.07 (15.36) | |
Gender, N (%) | 0.249 | ||
Female | 23 (26.4%) | 26 (19.5%) | |
Male | 64 (73.6%) | 107 (80.5%) | |
Casualty Population, N (%) | 0.390 | ||
Soldier | 28 (32.2%) | 51 (38.3%) | |
Not Soldier | 59 (67.8%) | 82 (61.7%) | |
Event Type, N (%) | 0.126 | ||
Military Circumstances | 9 (10.3%) | 25 (18.8%) | |
Non-military Circumstances | 78 (89.7%) | 108 (81.2%) | |
Injury Mechanism, N (%) | 0.625 | ||
MVC | 65 (74.7%) | 104 (78.2%) | |
Fall | 22 (25.3%) | 29 (21.8%) | |
Patient Outcomes | |||
Cervical Injury Present, N (%) | 9 (10.3%) | 9 (6.8%) | 0.451 |
Hospital Discharge, N (%) | 0.751 | ||
Death | 2 (2.3%) | 3 (2.3%) | |
Rehabilitation | 15 (17.2%) | 29 (21.8%) | |
Other | 70 (80.5%) | 101 (75.9%) | |
Disability Rate, N (%) | 0.618 | ||
None | 72 (82.8%) | 106 (79.7%) | |
0–19% | 2 (2.3%) | 4 (3.0%) | |
20–49% | 8 (9.2%) | 9 (6.8%) | |
50–99% | 2 (2.3%) | 10 (7.5%) | |
100% | 1 (1.1%) | 1 (0.8%) | |
Died | 2 (2.3%) | 3 (2.3%) | |
Disability Type, N (%) | |||
Cervical Spine: Chronic Pain, Limited ROM, or Spinal Fixation | 8 (9.2%) | 5 (3.8%) | 0.142 |
Hemiplegia | 2 (2.3%) | 2 (1.5%) | 0.649 |
Paraplegia | 0 (0.0%) | 1 (0.8%) | 1.000 |
Tetraplegia | 0 (0.0%) | 0 (0.0%) | 1.000 |
C-Spine Injury (N = 18) | No C-Spine Injury (N = 202) | p-Value | |
---|---|---|---|
Body Region, N (%) | |||
TL-spine | 10 (55.6%) | 38 (18.8%) | 0.001 |
Head | 10 (55.6%) | 82 (40.6%) | 0.225 |
Neck | 0 (0.0%) | 5 (2.5%) | 1.000 |
External | 0 (0.0%) | 3 (1.5%) | 1.000 |
Thorax | 12 (66.7%) | 80 (39.6%) | 0.043 |
Abdomen | 8 (44.4%) | 60 (29.7%) | 0.196 |
Face | 9 (50.0%) | 53 (26.2%) | 0.052 |
Upper Extremity | 8 (44.4%) | 74 (36.6%) | 0.612 |
Lower Extremity | 7 (38.9%) | 86 (42.6%) | 0.259 |
Hospital Discharge, N (%) | 0.031 | ||
Death | 2 (11.1%) | 3 (1.5%) | |
Rehabilitation | 5 (27.8%) | 39 (19.3%) | |
Other | 11 (61.1%) | 160 (79.2%) | |
Disability Rate, N (%) | 0.057 | ||
None | 13 (72.2%) | 165 (81.7%) | |
0–19% | 0 (0.0%) | 6 (3.0%) | |
20–49% | 3 (16.7%) | 14 (6.9%) | |
50–99% | 0 (0.0%) | 12 (5.9%) | |
100% | 0 (0.0%) | 2 (1.0%) | |
Died | 2 (11.1%) | 3 (1.5%) | |
Disability Type, N (%) | |||
Cervical Spine: Chronic Pain, Limited ROM, or Spinal Fixation | 3 (16.7%) | 10 (5.0%) | 0.078 |
Hemiplegia | 0 (0.0%) | 4 (2.0%) | 1.000 |
Paraplegia | 0 (0.0%) | 1 (0.5%) | 1.000 |
Tetraplegia | 0 (0.0%) | 0 (0.0%) |
Collar (N = 87) | No Collar (N = 133) | p-Value | |
---|---|---|---|
ALS Provider, N (%) | 0.211 | ||
Doctor Only | 7 (8.0%) | 17 (12.8%) | |
Paramedic Only | 36 (41.4%) | 64 (48.1%) | |
Doctor and Paramedic Together | 44 (50.6%) | 52 (39.1%) | |
Number of Casualties, N (%) | 0.531 | ||
1 | 46 (52.9%) | 63 (47.4%) | |
2–3 | 19 (21.8%) | 27 (20.3%) | |
4+ | 22 (25.3%) | 43 (32.3%) | |
AVPU, N (%) | 0.467 | ||
A | 54 (62.1%) | 90 (67.7%) | |
V | 6 (6.9%) | 7 (5.3%) | |
P | 7 (8.0%) | 9 (6.8%) | |
U | 13 (14.9%) | 11 (8.3%) | |
Missing Data | 7 (8.1%) | 16 (11.9%) | |
GCS, N (%) | 0.038 | ||
3–8 | 17 (19.5%) | 15 (11.3%) | |
9–13 | 8 (9.2%) | 8 (6.0%) | |
14–15 | 57 (65.5%) | 88 (66.2%) | |
Missing Data | 5 (5.8%) | 22 (16.5%) | |
Pain (VAS), N (%) | 0.961 | ||
0 | 1 (1.1%) | 1 (0.8%) | |
1–4 | 5 (5.7%) | 6 (4.5%) | |
5–10 | 40 (46.0%) | 61 (45.9%) | |
Missing Data | 41 (47.2%) | 65 (48.8%) | |
Hemodynamic Status, N (%) | 0.007 | ||
Shock | 8 (9.2%) | 6 (4.5%) | |
No Shock | 78 (89.7%) | 113 (85.0%) | |
Missing Data | 1 (1.1%) | 14 (10.5%) | |
Procedures, N (%) | |||
Backboard Immobilization | 58 (66.7%) | 21 (15.8%) | <0.001 |
Airway Only | 1 (1.1%) | 0 (0.0%) | 0.395 |
ETI | 14 (16.1%) | 11 (8.3%) | 0.085 |
Coniotomy | 2 (2.3%) | 0 (0.0%) | 0.155 |
Needle Decompression | 4 (4.6%) | 2 (1.5%) | 0.216 |
Chest Drain | 1 (1.1%) | 0 (0.0%) | 0.395 |
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Mitchnik, I.Y.; Ezra, Y.V.; Radomislensky, I.; Talmy, T.; Ankory, R.; Benov, A.; Gelikas, S. Lack of Association between Cervical Spine Injuries and Prehospital Immobilization: From Tradition to Evidence. J. Clin. Med. 2024, 13, 4868. https://doi.org/10.3390/jcm13164868
Mitchnik IY, Ezra YV, Radomislensky I, Talmy T, Ankory R, Benov A, Gelikas S. Lack of Association between Cervical Spine Injuries and Prehospital Immobilization: From Tradition to Evidence. Journal of Clinical Medicine. 2024; 13(16):4868. https://doi.org/10.3390/jcm13164868
Chicago/Turabian StyleMitchnik, Ilan Y., Yael V. Ezra, Irina Radomislensky, Tomer Talmy, Ran Ankory, Avi Benov, and Shaul Gelikas. 2024. "Lack of Association between Cervical Spine Injuries and Prehospital Immobilization: From Tradition to Evidence" Journal of Clinical Medicine 13, no. 16: 4868. https://doi.org/10.3390/jcm13164868