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Three Part Question

In [patients requiring full spinal immobilization] is [the use of a cervical collar, long board and head blocks better than long board and head blocks alone] at [cervical spine immobilization]?

Clinical Scenario

A paramedic crew brings a 27 year old patient with a suspected cervical spine injury to the emergency department following an RTA. At the scene of the accident the patient had full spinal immobilization, which consisted of a long spinal board, a correctly sized cervical collar, and head blocks with straps to secure the head to the board. In the emergency department the patient is becoming increasingly distressed by the presence of the neck collar and requests that it is removed. You wonder whether the cervical collar provides any additional benefit in terms of immobilizing the spine.

Search Strategy

Medline 1966-03/01 using the OVID interface AND hand searching relevant pre-hospital journals.
[(exp spinal injuries OR spinal injury$.mp OR back injuries OR back injury$.mp OR exp neck injuries OR neck injury$.mp OR exp spinal cord injuries OR spinal cord injury$.mp OR exp spinal fractures OR spinal fracture$.mp OR exp lumbar vertebrae OR lumbar spine injury$.mp OR exp thoracic vertebrae OR thoracic spine injury$ OR exp cervical vertebrae OR vertebral fracture$.mp OR cervical spinal injury$.mp OR exp multiple trauma OR multiple trauma.mp OR exp wounds and injuries OR trauma.mp) AND (exp immobilzation OR spine boards$.mp OR neck collar$.mp OR spinal immobilization$.mp OR cervical collar$.mp OR hard collar$.mp OR semi-rigid collar$.mp OR rigid collar$.mp)] LIMIT to human AND english.

Search Outcome

855 papers found of which 854 were irrelevant or of insufficient quality.The remaining paper is shown in the table.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Houghton L and Driscoll P, 1999, UK	24 healthy volunteers Two different cervical collars with and without head blocks and straps. Movement was assessed using goniometric techniques.	Clinical trial	Percentage neck movement	Collars produced a reduction of movement of 31-45%. Head blocks and straps produced a reduction of between 58-64%. When head blocks and straps were in place the addition of a collar was not beneficial.	Goniometric techniques can overestimate the actual cervical spine movement.

Comment(s)

There is no evidence of the effect in patients with cervical spinal injuries. Furthermore goniometric techniques do not assess the movement at an individual vertebral level.

Clinical Bottom Line

Cervical collars are of no additional benefit to patients already immobilised using a long spine board with head blocks.

References

1. Houghton L, Driscoll P. Cervical immobilization - are we achieving it? Pre-hosp Immed Care 1999;3:17-21.