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Three Part Question

In [patients requiring spinal immobilization] is [a vacuum mattress better than a long spinal board] at providing [comfort and immobilization]?

Clinical Scenario

A 60 year old man was involved in a road traffic accident at high speed. He was complaining of low back pain at the scene and he was immobilized on a long spinal board. When the patient arrived at the emergency department, he was very uncomfortable on the board and he requested removal. You wonder whether a vacuum mattress is more comfortable and provides better degree of immobilization.

Search Strategy

Cochrane database of Systematic Reviews, 2004, issue 3 & Medline 1966-2007 using the Ovid interface.
({exp vacuum OR vacuum$.mp OR vacuum splint$.mp OR vacuum matress$.mp} AND {back board$.mp OR backboard$.mp OR spin$ board$.mp} LIMIT to human AND english.

Search Outcome

13 papers were found of which 7 were relevant to the three part question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Lovell ME and Evans JH, 1994, UK	30 healthy volunteers 7 different support surfaces	Observational	Interface pressure	Vacuum stretcher interface pressure was 36.7mmHg whilst the pressure with spinal board was 115.5mmHg	Small numbers
Main PM and Lovell ME, 1996, UK	4 healthy volunteers 7 different support surfaces	Observational	Interface pressure	Vacuum splint most comfortable. P=<0.001	Only 4 subjects used in study
Johnson DR et al, 1996, New Mexico, Albuquerque	30 paramedic students Collar + vacuum splint vs collar + backboard vs vacuum splint only vs backboard only	PRCT	Speed of application	Fast application with vacuum splint P=<0.01	Small numbers No trauma patient
			Degree of immobilization	No significant difference in immobilization
			Comfort	Vacuum splint more comfortable P=<0.001
Hamilton RS and Pons PT, 1996, USA	26 healthy volunteers Cervical collar + backboard vs backboard vs cervical collar + vacuum splint vs vacuum splint	PRCT	Degree of immobilization	Significant increase in immobilization	Small numbers No trauma patient included
			Efficacy and comfort	Efficacy and comfort with vacuum splint P=<0.05
Chan D et al, 1996, USA	37 healthy volunteers Neck collar + backboard vs neck collar + vacuum mattress	PRCT	Pain	Significant more pain in spinal board group. P=<0.001	Small numbers Study on healthy volunteers, no trauma patient
Luscombe and Williams, 2003, UK	9 healthy volunteers Standard clothing and rigid neck collar on backboard versus standard clothing and rigid neck collar on vacuum mattress	Observational study	Comfort levels. Movements of head, sternum and pubic symphysis (pelvis) from a fixed point.	Perceived comfort levels were significantly better with the vacuum mattress than backboard. Vacuum mattresses prevents significantly more movement in the longitudinal and lateral planes when subjected to a gradual tilt.	Only 9 volunteers
Cross and Baskerville, 2001, USA	18 healthy volunteers. Subjects were placed in three different immobilization boards (hard spine board and two different vacuum splint models, identified as red and blue) for 60 minutes at a time with a two day washout period in between each immobilization	Prospective randomized crossover study	At 0, 30 and 60 minutes the subjects rated their pain at multiple locations using a visual analogue scale (VAS)	Mean pain scores at 30 and 60 minute were significantly higher in subjects who were immobilised using the hard spine board rather than either the red or blue vacuum mattress.	Small numbers of healthy subjects.

Comment(s)

A Cochrane review concluded that there were no relevant RCTs [1]. However studies done on volunteers have shown that the vacuum splint is more comfortable than long spinal boards with no loss of stability. A large randomised trial in trauma patients is required.

Editor Comment

This was published in Emerg Med J 2001;18(5):379-80. Online update by Mark Gilhooly, Manchester Royal Infirmary

Clinical Bottom Line

The vacuum mattress provide comparable spinal immobilization to the long spinal board with increased comfort.

References

1. Lovell ME, Evans JH. A comparison of the spinal board and the vacuum stretcher, spinal stability and interface pressure Injury 1994;25(3):179-80.
2. Main PW, Lovell ME. A review of 7 support surfaces with emphasis on their protection of the spinally injured. J Accid Emerg Med 1996;13:34-37.
3. Johnson DR, Hauswald M, Stockhoff C. Comparison of a vacuum splint device to a rigid backboard for spinal immobilization. Am J Emerg Med 1996;14(4):369-72.
4. Hamilton RS, Pons PT. The efficacy and comfort of full-body vacuum splint for cervical-spine immobilization J Emerg Med 1996;14(5):553-59.
5. Chan D, Goldberg RM, Mason J et al. Backboard vs mattress splint immobilization : a comparison of symptoms generated. J Emerg Med 1996;14(3):293-98.
6. Kwan I, Bunn F, Roberts I. Spinal immobilisation for trauma patients (Cochrane Review) The Cochrane Library Issue 3, 2004.
7. Luscombe MD, Williams JL. Comparison of a long spinal board and vacuum mattress for spinal immobilisation. Emerg Med J 2003;20:476-478.
8. Cross DA, Baskerville J. Comparison of perceived pain with different immobilisation techniques. Prehospital emergency care 2001;5:270-274.