Out-of-Hospital Management of Suspected Spinal Cord Injuries: How Much Evidence Does It Take to Change Practice?

Area of Science:

• Emergency Medicine
• Orthopaedic Surgery
• Medical Guidelines

Background:

• The debate continues regarding the efficacy and safety of spinal immobilization in trauma patients.
• Concerns have been raised about the need for multidisciplinary input in evaluating established medical practices.

Purpose of the Study:

• To address concerns about multidisciplinary team composition and the evidence base for spinal immobilization.
• To evaluate the maturity of evidence supporting or refuting the practice of spinal immobilization.

Main Methods:

• Review of clinical practice guidelines and literature analyses, including those from the Wilderness Medical Society.
• Inclusion of diverse medical specialists in expert panels, such as emergency physicians, orthopaedic surgeons, and paramedics.
• Analysis of evidence accumulated over 25 years regarding spinal immobilization outcomes.

Main Results:

• Multidisciplinary teams, including a broad range of specialists, consistently conclude that spinal immobilization is not beneficial.
• Evidence demonstrates that spinal immobilization is a harmful intervention with no demonstrable evidence-based benefit.
• Over a quarter-century of research has reinforced the conclusion that spinal immobilization should be abandoned.

Conclusions:

• Established practice of spinal immobilization is not supported by evidence and is demonstrably harmful.
• Further studies are not required; decades of data indicate the need to discontinue this practice.
• Patient safety necessitates the discontinuation of spinal immobilization due to its harmful effects.