PDF(Pubmed)
Abstract：
OBJECTIVE: To assess whether different cervical spine immobilisation strategies (full immobilisation, movement minimisation or no immobilisation), impact neurological and/or other outcomes for patients with suspected cervical spinal injury in the pre-hospital and emergency department setting.
METHODS: Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
METHODS: MEDLINE, EMBASE, CINAHL, Cochrane Library and two research registers were searched until September 2023.
METHODS: All comparative studies (prospective or retrospective) that examined the potential benefits and/or harms of immobilisation practices during pre-hospital and emergency care of patients with a potential cervical spine injury (pre-imaging) following blunt trauma.
METHODS: Two authors independently selected and extracted data. Risk of bias was appraised using the Cochrane ROBINS-I tool for non-randomised studies. Data were synthesised without meta-analysis.
RESULTS: Six observational studies met the inclusion criteria. The methodological quality was variable, with most studies having serious or critical risk of bias. The effect of cervical spine immobilisation practices such as full immobilisation or movement minimisation during pre-hospital and emergency care did not show clear evidence of benefit for the prevention of neurological deterioration, spinal injuries and death compared with no immobilisation. However, increased pain, discomfort and anatomical complications were associated with collar application during immobilisation.
CONCLUSIONS: Despite the limited evidence, weak designs and limited generalisability, the available data suggest that pre-hospital cervical spine immobilisation (full immobilisation or movement minimisation) was of uncertain value due to the lack of demonstrable benefit and may lead to potential complications and adverse outcomes. High-quality randomised comparative studies are required to address this important question.
BACKGROUND: PROSPERO REGISTRATION Fiona Lecky, Abdullah Pandor, Munira Essat, Anthea Sutton, Carl Marincowitz, Gordon Fuller, Stuart Reid, Jason Smith. A systematic review of cervical spine immobilisation following blunt trauma in pre-hospital and emergency care. PROSPERO 2022 CRD42022349600 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022349600.
METHODS: Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
METHODS: MEDLINE, EMBASE, CINAHL, Cochrane Library and two research registers were searched until September 2023.
METHODS: All comparative studies (prospective or retrospective) that examined the potential benefits and/or harms of immobilisation practices during pre-hospital and emergency care of patients with a potential cervical spine injury (pre-imaging) following blunt trauma.
METHODS: Two authors independently selected and extracted data. Risk of bias was appraised using the Cochrane ROBINS-I tool for non-randomised studies. Data were synthesised without meta-analysis.
RESULTS: Six observational studies met the inclusion criteria. The methodological quality was variable, with most studies having serious or critical risk of bias. The effect of cervical spine immobilisation practices such as full immobilisation or movement minimisation during pre-hospital and emergency care did not show clear evidence of benefit for the prevention of neurological deterioration, spinal injuries and death compared with no immobilisation. However, increased pain, discomfort and anatomical complications were associated with collar application during immobilisation.
CONCLUSIONS: Despite the limited evidence, weak designs and limited generalisability, the available data suggest that pre-hospital cervical spine immobilisation (full immobilisation or movement minimisation) was of uncertain value due to the lack of demonstrable benefit and may lead to potential complications and adverse outcomes. High-quality randomised comparative studies are required to address this important question.
BACKGROUND: PROSPERO REGISTRATION Fiona Lecky, Abdullah Pandor, Munira Essat, Anthea Sutton, Carl Marincowitz, Gordon Fuller, Stuart Reid, Jason Smith. A systematic review of cervical spine immobilisation following blunt trauma in pre-hospital and emergency care. PROSPERO 2022 CRD42022349600 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022349600.
摘要：
目的：评估不同的颈椎固定策略（完全固定，运动最小化或无固定)，对院前和急诊科疑似颈椎损伤患者的神经系统和/或其他结局有影响。
方法：系统评价遵循系统评价和荟萃分析指南的首选报告项目。
方法：MEDLINE，EMBASE,CINAHL,搜索了Cochrane图书馆和两个研究登记册，直到2023年9月。
方法：所有比较研究（前瞻性或回顾性），这些研究检查了钝性创伤后潜在颈椎损伤（影像学前）患者院前和急诊护理期间固定治疗的潜在益处和/或危害。
方法：两位作者独立选择和提取数据。使用CochraneROBINS-I工具对非随机研究评估偏倚风险。数据的合成没有荟萃分析。
结果：6项观察性研究符合纳入标准。方法学质量是可变的，大多数研究都有严重或严重的偏倚风险。在院前和急诊护理期间，颈椎固定的做法，如完全固定或运动最小化，没有明确的证据表明对预防神经系统恶化有益。脊髓损伤和死亡与无固定相比。然而,疼痛加重,不适和解剖并发症与固定过程中的衣领应用有关。
结论：尽管证据有限，弱设计和有限的泛化能力，现有数据表明,院前颈椎固定(完全固定或运动最小化)由于缺乏明显的获益而价值不确定,并且可能导致潜在的并发症和不良结局.需要高质量的随机比较研究来解决这个重要问题。
背景：PROSPERO注册FionaLecky，AbdullahPandor,MuniraEssat,AntheaSutton,卡尔·马林科维茨,戈登·富勒,斯图尔特·里德,杰森·史密斯.院前和急诊护理中钝性创伤后颈椎固定的系统评价。PROSPERO2022CRD42022349600可从以下网址获得：https://www.crd.约克。AC.uk/prospro/display_record.php?ID=CRD42022349600。
方法：系统评价遵循系统评价和荟萃分析指南的首选报告项目。
方法：MEDLINE，EMBASE,CINAHL,搜索了Cochrane图书馆和两个研究登记册，直到2023年9月。
方法：所有比较研究（前瞻性或回顾性），这些研究检查了钝性创伤后潜在颈椎损伤（影像学前）患者院前和急诊护理期间固定治疗的潜在益处和/或危害。
方法：两位作者独立选择和提取数据。使用CochraneROBINS-I工具对非随机研究评估偏倚风险。数据的合成没有荟萃分析。
结果：6项观察性研究符合纳入标准。方法学质量是可变的，大多数研究都有严重或严重的偏倚风险。在院前和急诊护理期间，颈椎固定的做法，如完全固定或运动最小化，没有明确的证据表明对预防神经系统恶化有益。脊髓损伤和死亡与无固定相比。然而,疼痛加重,不适和解剖并发症与固定过程中的衣领应用有关。
结论：尽管证据有限，弱设计和有限的泛化能力，现有数据表明,院前颈椎固定(完全固定或运动最小化)由于缺乏明显的获益而价值不确定,并且可能导致潜在的并发症和不良结局.需要高质量的随机比较研究来解决这个重要问题。
背景：PROSPERO注册FionaLecky，AbdullahPandor,MuniraEssat,AntheaSutton,卡尔·马林科维茨,戈登·富勒,斯图尔特·里德,杰森·史密斯.院前和急诊护理中钝性创伤后颈椎固定的系统评价。PROSPERO2022CRD42022349600可从以下网址获得：https://www.crd.约克。AC.uk/prospro/display_record.php?ID=CRD42022349600。
