Abstract：
OBJECTIVE: Cervical spinal immobilisation procedures often include rigid cervical collars which, despite associated complications, may provide less immobilisation than previously thought. The present study reports the incidence of worsening neurological outcomes following soft collar application, and additionally reports patient comfort, compliance with spinal immobilisation, and paramedic perspectives on usage.
METHODS: This was an observational cohort study conducted in selected metropolitan and regional areas of NSW Ambulance between 1 May 2022 and 31 March 2023. Soft collars were used exclusively in place of rigid collars. The SPEED (SPinal Emergency Evaluation of Deficits) tool was used to evaluate new or worsening neurological deficits following pre-hospital soft collar application. Secondary outcomes included patient-reported comfort of the device, and paramedic assessment of efficacy.
RESULTS: Overall, 2098 soft collars were applied, of which 74 patients (3.5%) were subsequently found to have a cervical spine injury. Eight patients had a spinal cord injury, of which two experienced a worsening neurological deficit after soft collar application. In both instances, comprehensive case reviews determined that this was unlikely to have been attributable to the soft collar. The majority of patients found the soft collar comfortable, and they were well-tolerated by patients who generally complied with immobility directions. Paramedics found the collar easy to apply, and felt it assisted in minimising patient movement.
CONCLUSIONS: Pre-hospital use of soft collars does not appear to increase the risk of significant injury. Patients found these devices relatively comfortable, and clinicians reported overall ease of use with good patient compliance with immobility directives.
METHODS: This was an observational cohort study conducted in selected metropolitan and regional areas of NSW Ambulance between 1 May 2022 and 31 March 2023. Soft collars were used exclusively in place of rigid collars. The SPEED (SPinal Emergency Evaluation of Deficits) tool was used to evaluate new or worsening neurological deficits following pre-hospital soft collar application. Secondary outcomes included patient-reported comfort of the device, and paramedic assessment of efficacy.
RESULTS: Overall, 2098 soft collars were applied, of which 74 patients (3.5%) were subsequently found to have a cervical spine injury. Eight patients had a spinal cord injury, of which two experienced a worsening neurological deficit after soft collar application. In both instances, comprehensive case reviews determined that this was unlikely to have been attributable to the soft collar. The majority of patients found the soft collar comfortable, and they were well-tolerated by patients who generally complied with immobility directions. Paramedics found the collar easy to apply, and felt it assisted in minimising patient movement.
CONCLUSIONS: Pre-hospital use of soft collars does not appear to increase the risk of significant injury. Patients found these devices relatively comfortable, and clinicians reported overall ease of use with good patient compliance with immobility directives.
摘要：
目的：颈椎固定手术通常包括僵硬的颈项圈，尽管相关的并发症，可能会提供比以前认为更少的固定。本研究报告了软领应用后神经系统预后恶化的发生率，并额外报告患者的舒适度，符合脊髓固定，和护理人员对使用的看法。
方法：这是一项观察性队列研究，在2022年5月1日至2023年3月31日期间，在新南威尔士州救护车的选定大都市和地区进行。软项圈专门用于代替刚性项圈。SPEED（脊髓急诊缺陷评估）工具用于评估院前软领应用后新的或恶化的神经功能缺损。次要结果包括患者报告的设备舒适度，和护理人员的疗效评估。
结果：总体而言，应用了2098个软领，其中74名患者（3.5％）随后被发现患有颈椎损伤。八名患者有脊髓损伤，其中两人在应用软领后神经功能缺损恶化。在这两种情况下，全面的案例审查确定，这不太可能归因于软领。大多数患者发现柔软的衣领舒适，通常遵守不动的患者对它们的耐受性良好。护理人员发现领子很容易应用，并觉得它有助于最大限度地减少病人的运动。
结论：院前使用软领似乎不会增加重大损伤的风险。患者发现这些设备相对舒适，临床医生报告总体上易于使用,患者对固定指令的依从性良好.
方法：这是一项观察性队列研究，在2022年5月1日至2023年3月31日期间，在新南威尔士州救护车的选定大都市和地区进行。软项圈专门用于代替刚性项圈。SPEED（脊髓急诊缺陷评估）工具用于评估院前软领应用后新的或恶化的神经功能缺损。次要结果包括患者报告的设备舒适度，和护理人员的疗效评估。
结果：总体而言，应用了2098个软领，其中74名患者（3.5％）随后被发现患有颈椎损伤。八名患者有脊髓损伤，其中两人在应用软领后神经功能缺损恶化。在这两种情况下，全面的案例审查确定，这不太可能归因于软领。大多数患者发现柔软的衣领舒适，通常遵守不动的患者对它们的耐受性良好。护理人员发现领子很容易应用，并觉得它有助于最大限度地减少病人的运动。
结论：院前使用软领似乎不会增加重大损伤的风险。患者发现这些设备相对舒适，临床医生报告总体上易于使用,患者对固定指令的依从性良好.
