Table 2.
Characteristics of the included studies
| Study | Study location | Type | Patients | GRADE quality | Main findings relevant to pre-hospital use of collars |
|---|---|---|---|---|---|
| Underbrink et al. [21] | Rocky Mountain | 4-year retrospective study | 5063 | High | No differences in neurologic deficit or patient disposition in the older adult patient with cervical spine trauma despite changes in spinal restriction protocols and resulting differences in immobilization devices |
| Oosterwold et al. [19] | Netherlands | Retrospective observational study | 1082 | Moderate | Consensus among EMS staff on how to interpret the criterion ‘distracting injury’ was lacking. Adverse effects of spinal immobilisation were incompletely documented in pre-hospital care reports. To provide validated information on potential symptoms of SCI, a uniform EMS scoring system for motoric assessment should be developed |
| Vanderlan et al. [22] | Louisiana State, USA | Retrospective observational study | 199 | Moderate | Cervical spine immobilisation was associated with an increased risk of death (p < 0.02, Odds ratio 2.77, 95% CI 1.18–6.49) |
| Haut et al. [16] | USA | Retrospective observational study | 45,284 | High | Pre-hospital spine immobilisation was associated with higher mortality in penetrating trauma and should not be routinely used in every patient with penetrating trauma |
| Brown et al. [14] | New York, USA | Retrospective observational study | 75,567 | High | Documented benefits of pre-hospital spinal immobilisation in patients with torso gunshot wounds remains unproven, despite the potential to interfere with emergent care in this patient population |
| Hauswalk et al. [15] | Malaysia and New Mexico | Retrospective observational study | 454 | Moderate | Out-of-hospital immobilisation has little or no effect on neurologic outcome in patients with blunt spinal injuries |
| Lemyze et al. [17] | Unknown | Retrospective observational study | 1 | Low | Early removal of a neck stabilisation can increase harm to patients after hanging due to raised intracranial pressure |
| Lin et al. [18] | Asia | Retrospective observational study | 8633 | High | Incidence of cervical spinal injuries in the urban area lightweight motorcyclist is very low. Pre-hospital protocol for application of a cervical collar brace to people who have sustained a lightweight motorcycle accident in the urban area should be revised to avoid unnecessary restraint and possible complications |
| Barkana et al. [13] | Israel | Retrospective observational study | 36 | Moderate | Life-threatening complications due to penetrating neck injury are common and may be overlooked if the neck is covered by a stabilisation device |