Table 1. Study and population characteristics.
| Author, year | Country (setting) | Design | Single/ multi-centre | Sample size | Population | Period | Mean age (years) | Female | Mechanism (and type) of injury | Intervention | Comparator | Primary outcome(s) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Full ‘triple’ immobilisation vs. no immobilisation | ||||||||||||
| Hauswald et al. 1998 [23] | Malaysia, USA (pre-hospital) |
Retrospective analysis (chart review) | Multi (2 sites) |
454 | Patients with acute blunt traumatic spinal or spinal cord injuries | January 1988 to January 1993 | 35 | 20.3% | Falls: 28%; RTA: 65%; Other: 7% (100% blunt) |
Full spinal immobilisation,a (USA cohort, n = 334) |
No spinal immobilisation (Malaysia cohort, n = 120) |
Rate of neurologic injury |
| Full ‘triple’ immobilisation vs. movement minimisation | ||||||||||||
| Thompson et al. [Unpublished] b | UK (pre-hospital) |
Prospective controlled “before after” interventional study c | Single | 56 | Trauma patients (≥18 years) with suspected cervical spine injury | December 2020 to August 2021 |
62.3 | 50.0% | Falls: 68%; RTA: 23%; Other: 9% (NR) d |
Full spinal immobilisation (defined as the use of semi-rigid collar, blocks, and tape +/- orthopaedic stretcher/scoop or vacuum mattress; n = 30) |
Movement minimisation (defined as the use of blocks and tape but no semi-rigid collar (n = 26) | Time: on scene, to imaging, in ED and new neurology |
| Underbrink et al. 2018 [24] | USA (pre-hospital) | Retrospective before-and-after study | Multi (9 sites) |
237 | Adults (≥60 years) with a cervical spine injury (fracture or cord) | January 2012 and June 2014 to July 2014 and December 2015 | 78.2 | 48.5% |
Falls: 65%; RTA: 23%; Other: 12% (NR) d |
Full spinal immobilisation (defined as the use of backboard, cervical collar and head immobilisation devices; Before cohort, n = 123) | Movement minimisation (defined as the use of collar only; After cohort, n = 114) | NR but included immobilisation type, presence of neurological deficit, patient disposition at discharge, and in-hospital mortality/ hospice |
| Movement minimisation vs. No immobilisation | ||||||||||||
| Asha et al. 2021 [25] | Australia (pre-hospital and ED) |
Retrospective analysis (chart review) | Multi (7 sites) |
2036 | Patients with suspected traumatic cervical spine injury | October 2017 to July 2018 | NR (median, 54) | 44.1% | Falls: 39%; RTA: 24% (motorcycle: 6%; motor vehicle: 18%); Other: 37% (NR) d |
Movement minimisation (defined as [1] the pre-hospital and ED use of hard collar until imaging and then removed if no injury identified (n = 268) or [2] pre-hospital hard collar, and then soft collar in ED until imaging. If injured changed to hard collar or removed if no injury identified, n = 1133) | No immobilisation (n = 582) | Proportion who developed new or worsening neurological deficit |
| Leonard et al. 2012 [26] | USA (pre-hospital and ED) | Prospective cohort study | Single | 285 | Children (<18 years) with suspected traumatic cervical spine injury | July 2003 to August 2004 | NR | 47.0% | Falls: 29%; RTA: 43%; Other: 28% (NR) d |
Movement minimisation (defined as the use of cervical collar and/or rigid spine board, n = 173) | No immobilisation (n = 112) | Level of pain on ED arrival and rate of cervical spine imaging |
| Lin et al. 2011 [27] | Taiwan (pre-hospital) | Retrospective analysis (chart review) | Single | 5139 | Patients who sustained lightweight motorcycle (engine size <150 mL) injuries, assumed to have been at a low velocity (<50 km/h), with suspected cervical spine injury |
January 2008 to December 2009 | 38 |
45.1% | RTA: 100% (motorcycle) (100% blunt) |
Movement minimisation (defined as the use of cervical collar brace only, n = 2605) | No immobilisation (n = 2534) | Incidence of cervical spine injury |
Abbreviations: ED, emergency department; NR, not reported; RTA, road traffic accident.
a Not clearly defined. We assumed this based on description in the introductory text which states ‘Immobilization is improved by using a firm surface; addition of a hard cervical collar, head blocks, and lateral restraint provides progressively more stability… Patients are fully immobilized at the injury site if there is any suggestion that the neck or back could be injured. Immobilization is usually continued in the ED until the spine is “cleared” by multiple imaging procedures.
b For further details see https://www.neas.nhs.uk/our-services/research-and-development/smrf.aspx.
c This study was originally designed as a feasibility randomised controlled trial (https://www.isrctn.com/ISRCTN11400471); however, due to the impact and restrictions of the COVID-19 pandemic and limited resources intervention/control assignment was made based on two three-month timeframe periods into before (full immobilisation) and after (movement minimisation) groups.
d Although not explicitly reported in the published manuscript, we assumed that most patients had blunt trauma based on the mechanism of injury.