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Is the immobilization of a traumatized patient still the best practice? A literature review
¿La inmovilización de un paciente traumatizado sigue siendo la mejor práctica? Una revisión de la literatura
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A literature review" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "293" "paginaFinal" => "298" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Caterina Zardo, Antonello Carta" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Caterina" "apellidos" => "Zardo" "email" => array:1 [ 0 => "catezardo@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Antonello" "apellidos" => "Carta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Emergency Department, UOC SUEM 118, Venice, Italy" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Chief Nursing Officer, Mirano and Dolo Hospitals, Venice, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿La inmovilización de un paciente traumatizado sigue siendo la mejor práctica? Una revisión de la literatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 966 "Ancho" => 1350 "Tamanyo" => 114979 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cervical collar, spine boards and strap.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The social impact of a traumatic event is extremely significant as it often affects young and working-age patients who require prolonged care and a high level of specialization. Globally, complications from major trauma will be the third leading cause of disability by 2030. Trauma in Western countries is the third leading cause of death after cardiovascular disease and cancer and, globally, the leading cause of death in the population aged 18–29 years.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a> Approximately 5 million people die each year due to traumatic injuries and 90% of these deaths occur in low and middle-income countries. Studies have shown that mortality due to trauma is inversely related to the economic level of a country.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">1,2</span></a> In high-income countries, the implementation of trauma care systems has led to a significant decrease in mortality and disability and is estimated to prevent approximately one third of injury-related deaths. Epidemiologically, cervical spine injuries occur in 2–3% of all victims of blunt trauma. Injuries can range from mild ligament sprains to complete fracture-dislocations resulting in severe spinal cord injury (SCI).<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">3</span></a> Approximately two thirds of all fractures and three quarters of all dislocations involve the sub-axial cervical spine. The sixth and seventh cervical vertebrae together account for 39% of all cervical spine fractures.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">3</span></a> The most common causes of cervical spine injuries are motor vehicle accidents (41%), falls (27%), violence (15%) and sports-related injuries (8%).<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">3</span></a> The application of a cervical collar and spinal board has been a standard procedure in trauma patients for many years and is highly recommended in many national and international guidelines for accident patients.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a> However, the current literature also describes an increase in complications after the application of cervical collar and spinal boards.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a> The aim of this Mini-Review is to investigate whether the current systems of immobilization of a trauma patient still represent best practice in out-of-hospital emergency care.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">The authors based their search on the question: Are current patient immobilization techniques still the best practice? Review of original and secondary articles of any design, including keywords such as: trauma patient, immobilization systems, emergency, best practice. The search was conducted by applying a time filter (last 10 years) and a language filter (only English language studies). Likewise, the use in part of the title or abstract, which were published in health sciences journals. Initially, all potentially relevant article abstracts were reviewed. If it met the aforementioned inclusion criteria, the article was analyzed by the researchers and later an extraction and classification of the most relevant data was carried out, depending on the study design. Most publications were eliminated on the basis of their title (43). The others (263) were eliminated after reading the abstract and full text (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The inclusion criteria for the articles selection were: guidelines and effects of immobilization techniques. A total of 329 studies were identified in the databases and, after the review process, only 23 studies were included. Subsequently, the present manuscript was prepared.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Spinal and cervical spine immobilization</span><p id="par0015" class="elsevierStylePara elsevierViewall">Colloquially referred to as ‘collared and boarded’ immobilization has been standard clinical practice for many years for transporting patients with potential spinal injuries.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">6</span></a> Spinal immobilization involves the immobilization of the head, neck and body in neutral alignment.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">7</span></a> This is achieved using cervical collars, lateral support, spine boards and straps (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Other devices used include a spoon stretcher with a rigid cervical collar and straps, a vacuum mattress (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) in combination with a rigid cervical collar, and a Kendrick extrication device – KED, also known as a short board – (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>) to assist with extrication after a motor vehicle accident or other rescue in confined spaces.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Pre-hospital spinal immobilization is a widely accepted practice for patients with suspected SCI and aims to minimize further movement of the spine, reduce the risk of secondary injuries and facilitate extrication and transport.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">7</span></a> However, it has several disadvantages, including increased risk of respiratory compromise, back and neck pain, risk of pressure sores, and increased intracranial pressure associated with cervical collar application. It also does not appear to prevent the progression of neurological damage.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">7</span></a> Cervical spine immobilization methods were adopted worldwide and were not questioned until the 2000s. From the 1970s to the 1980s, the incidence and mortality of spinal injuries decreased significantly, and as this coincided with the introduction of modern spinal management strategies, several experts credited spinal stabilization with this reduction.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">8</span></a> As the literature has provided little empirical evidence on the benefits of traditional immobilization and has indicated potential negative consequences, some authors have suggested that a culture of immobilization has been created without evidence of patient benefit.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">6,8,9</span></a> Although the effect of spinal immobilization on patient mortality and outcome remains uncertain due to the lack of randomized controlled trials, current guidelines strictly recommend spinal immobilization for patients with traumatic spinal cord injury.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">2,4,7,9</span></a> However, there is the caveat that anatomy deformity, confusional state or agitation require a pragmatic approach and aim for a comfortable position for the patient. It follows that the indication was not to abandon immobilization strategies, but to adopt a selective approach with minimal manipulation to reduce spinal movement, reduce pain and potentially promote hemostasis.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">3</span></a> Little evidence exists on the relationship between pre-hospital immobilization and its effect on neurological outcomes of.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">2</span></a> Several studies have shown that despite proper application of the spinal board, functional immobilization is not actually achieved, moving the risk–benefit ratio away from recommending its use.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">10,11</span></a> The method of movement restriction must be chosen according to the situation and the use of a vacuum mattress is the preferred technique, while the use of a trauma board is the least desirable.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">9,12</span></a> Although immobilization of the spine and restriction of movement are performed as a matter of practice by specialized personnel and millions of patients with cervical spine trauma are equipped with a collar, in recent years a growing body of evidence points the need to reconsider the routine use of cervical collars and rigid backboards in pre-hospital trauma care.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">2</span></a> It is essential to keep in mind that not all patients require immobilization and that excessive manipulation and inappropriate restriction of spinal motion may cause further neurological damage and worsen patient outcome.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">2</span></a> Exclusion of spinal trauma may be straightforward in patients without neurological deficits, pain or tension along the spine. The presence of a cervical collar and backboard can provide a false sense of security. Indeed, if the patient is not properly immobilized, movement of the spine is still possible.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">2,8,13</span></a> A study that examined practical skills in the application of a commercial cervical collar showed that only 11% of the subjects examined were able to apply a cervical collar properly in all details.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a> The most common sources of error included the selection of the correct size of the cervical collar and the correct size measurement on the training doll. This can lead to the application of an excessively large cervical collar and thus to increased distraction of the cervical vertebrae, resulting in serious complications.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a> Some authors systematically reviewed the literature to clarify whether the application of a cervical collar on adult trauma patients in the prehospital setting improved patient outcome.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a> Despite the contradictory elements in the literature regarding emergency management of a suspected spinal cord injury, there is agreement that there is a paucity of high-level evidence to support the theory that restricting movement of a potentially injured spine reduces the likelihood of injury progression and neurological deficit. However, there is insufficient evidence to validate the complete abandonment of cervical spine and cervical spine immobilization maneuvers.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">6,7</span></a> A study conducted on elderly trauma patients (>60 years) with a cervical spine injury demonstrated a change in the type of immobilization devices to be used.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a> Despite the change in immobilization devices, with less complete immobilization, outcomes did not change, leading to no development of neurological deficits or increased mortality rates.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a> Spinal stabilization may preclude or delay effective management of life-threatening reversible insults, such as airway compromise, hypoxemia, tension pneumothorax, cardiac tamponade, hemorrhage or brain trauma, which may require urgent pre-hospital or hospital interventions.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> Furthermore, spinal stabilization has been associated with difficult airway management, limited thoraco pulmonary function and delayed intervention time. Thus, while remaining an important element, spinal stabilization should not interfere with or delay life-saving interventions.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">7</span></a> Evidence for the use of cervical spine immobilization in elderly patients is scarce.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a> Its use in the initial transfer and management of patients after trauma is widely accepted, but pragmatic alternative stabilization methods should be considered in elderly patients with significant degenerative deformities.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a> In an Australian study, controversy surrounding pre-hospital spinal immobilization was highlighted, identifying differences of opinion among emergency medicine physicians on whether patients with potential spinal injury should be immobilized in situ. The results of this survey helped to identify areas of conflict and uncertainty in the treatment of patients with suspected spinal cord injury.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a> Cervical spine immobilization is a routine component of pre-hospital care of patients after blunt trauma, although there is little evidence in the literature to support this practice.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">14</span></a> So how does one determine who really needs to be immobilized? This question has been answered in the last decade by several studies that have shown that the risk of immobilization is greater than the benefit of immobilization.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">4,11,15</span></a> The determination of appropriate indications for immobilization after blunt trauma could best be achieved through the implementation and validation of progressively more liberal field clearance protocols.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> Recently, adverse events due to the method of immobilization have called into question the need to restrict movement in all trauma patients.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a> To date, no study in human patients has shown a clear benefit from the application of a rigid cervical collar in patients with neck injuries.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a> Because of the risk of these adverse events and the lack of efficacy, the use of rigid cervical collars is not recommended and the choice of devices for transporting patients with movement limitations should be made in the following descending order of preference: (1) vacuum mattress, (2) scoop stretcher and (3) movement limitations even on a standard ambulance stretcher. Transporting a patient on a trauma board is strongly discouraged. Although it is a valuable tool for moving patients, there is no benefit in transporting a patient on this device.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Criteria for spinal immobilization</span><p id="par0025" class="elsevierStylePara elsevierViewall">The AANS/CNS guidelines for the management of acute cervical spine and spinal cord injuries list clinical criteria for assessing patients appropriate for spinal immobilization<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">12,16–18</span></a>: 1. pain in the spine on palpation or movement, 2. significant multiple systemic trauma, 3. severe head or facial trauma, 4. evidence deformity of the spine, 5. numbness or weakness in any extremity after trauma, 6. loss of sensation and feeling, 7. loss of consciousness caused by trauma, 8. unexplained hypotension associated with absence of tachycardia, 9. altered mental status when the patient is found in a context of possible trauma (e.g., at the bottom of stairs or in the street), and 10. any significant distractive injury. In patients without signs of cervical trauma, immobilization is generally not recommended. Immobilization of the spine in patients with penetrating trauma is not recommended because of increased mortality due to delayed resuscitation. Nurses can safely influence clinical care by eliminating unnecessary immobilization.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> In Canada, a tool, the C-Spine Rule, has been developed to improve the care of patients with traumatic injuries. Where this tool is used, there has been a substantial rate of removal of cervical spine immobilization, with trained nurses releasing 41.1% of stable patients and correctly identifying non-immobilized patients found to have cervical spine injuries.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> A Cochrane systematic review emphasizes the need for randomized control trials in trauma patients to advance practice in the use of alternative strategies to spinal immobilization and recommends the development of an algorithm to reduce the incidence of unnecessary immobilization of the spine.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a> This review also states that cervical collar immobilization is only necessary if the trajectory of the patient's fall suggests a direct injury to the spine. But even in these cases, the guidelines recommend that alert patients without neurological deficit, neck pain or distractive injuries should not receive cervical spine immobilization and in all cases cervical collars should be removed as soon as possible after the trauma.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a> The Trauma Committee of the American College of Surgeons suggests a limited application of spinal immobilization, stating that the number of patients who can benefit from immobilization is very small.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Effects of immobilization</span><p id="par0030" class="elsevierStylePara elsevierViewall">It is becoming increasingly common to stop the routine use of spinal immobilization.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">2</span></a> Numerous risks are reported because of immobilization, including increased intracranial pressure, formation of pressure ulcers, increased difficulty in clinical examination, prolonged hospital stay, difficulty in performing vital procedures such as endotracheal intubation, improper positioning of cervical collars, and risk of fracture displacement in the elderly.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">2,10,20</span></a> Spinal immobilization in adult patients with penetrating trauma is associated with increased mortality and has not been shown to have a beneficial effect on reducing neurological deficits, even potentially reversible ones.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">10,21</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Despite the obvious potential benefits, spinal immobilization is not without risk and even proper immobilization may be associated with increased pain in an awake trauma patient. The application of proper spinal immobilization is time consuming and could potentially delay transport.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">11,20</span></a> Complications caused by immobilization with a rigid collar are well known, including increased pain, increased intracranial pressure, risk of aspiration, missed injuries, pressure sores and difficulty securing the airway.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a> Regarding cervical collar use, a systematic review found an incidence of collar-related pressure ulcers ranging from 6.8% to 38%, usually in the occiput, chin, shoulders and back. General immobility due to immobilization of the cervical spine can also lead to pressure ulcers at other sites, such as the sacrum, elbows and heels.<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">22,23</span></a> Respiration has been found to be affected by rigid cervical spine immobilization, with significant reductions in FEV1 (forced expiratory volume over 1<span class="elsevierStyleHsp" style=""></span>s) and FVC (forced vital capacity).<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">16,22</span></a> Pneumonia remains the most frequent complication of cervical spine immobilization in several case series of elderly patients. Cervical bracing has also been found to impair swallowing, even in young, healthy individuals.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">16,22</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="par0040" class="elsevierStylePara elsevierViewall">The practice of spinal immobilization remains controversial regarding its possible benefits or harms in trauma patients. There is no evidence that clearly defines if the immobilization techniques remain the best practice in assisting trauma patient. Comparative studies are needed to evaluate the safety of cervical and spinal immobilization. Further outcome studies comparing immobilization modalities should be conducted to obtain evidence-based recommendations.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a> The need for movement restriction in cases of suspected spinal injury must be properly assessed and appropriate measures should be taken. Not all trauma patients require spinal motion restriction.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">8</span></a> Although the effects of spinal injuries are severe, healthcare professionals must provide appropriate care that limits injury to the spinal cord and does not result in adverse events.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">8</span></a> Further investigation of this issue is necessary: although there is a great deal of evidence in the literature that advises against immobilization of the spine and cervical spine, these remain the treatment of first choice in the management of trauma patients.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Authors’ contributions</span><p id="par0045" class="elsevierStylePara elsevierViewall">All authors listed have made a substantial, direct, and intellectual contribution to the work, and approved it for publication.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1952333" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1680606" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1952332" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1680605" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Spinal and cervical spine immobilization" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Criteria for spinal immobilization" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Effects of immobilization" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Authors’ contributions" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-11-08" "fechaAceptado" => "2023-03-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1680606" "palabras" => array:4 [ 0 => "Trauma patient" 1 => "Immobilization systems" 2 => "Emergency" 3 => "Best practice" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1680605" "palabras" => array:4 [ 0 => "Paciente traumatizado" 1 => "Sistemas de inmovilización" 2 => "Emergencia" 3 => "Mejores prácticas" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cervical spine immobilization methods were adopted worldwide and were not questioned until the 2000s. From the 1970s to the 1980s, the incidence and mortality of spinal injuries decreased significantly, and as this coincided with the introduction of modern spinal management strategies, several experts credited spinal stabilization with this reduction. As the literature has provided little empirical evidence on the benefits of traditional immobilization and has indicated potential negative consequences, some authors have suggested that a culture of immobilization has been created without evidence of patient benefit. Although the effect of spinal immobilization on patient mortality and outcome remains uncertain due to the lack of randomized controlled trials, current guidelines strictly recommend spinal immobilization for patients with traumatic spinal cord injury. The practice of spinal immobilization remains controversial regarding its possible benefits or harms in trauma patients. Comparative studies are needed to evaluate the safety of cervical and spinal immobilization. The aim of this Mini-Review is to investigate whether the current systems of immobilization of a trauma patient still represent best practice in out-of-hospital emergency care.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los métodos de inmovilización de la columna cervical se adoptaron en todo el mundo y no se cuestionaron hasta la década de 2000. Desde la década de 1970 hasta la década de 1980, la incidencia y mortalidad de las lesiones medulares disminuyó significativamente, y como esto coincidió con la introducción de estrategias modernas de manejo de la columna, varios expertos acreditaron la estabilización espinal con esta reducción. Como la literatura ha proporcionado poca evidencia empírica sobre los beneficios de la inmovilización tradicional y ha indicado posibles consecuencias negativas, algunos autores han sugerido que se ha creado una cultura de inmovilización sin evidencia de beneficio para el paciente. Aunque el efecto de la inmovilización espinal sobre la mortalidad y el desenlace del paciente sigue siendo incierto debido a la falta de ensayos controlados aleatorios, las guías actuales recomiendan estrictamente la inmovilización espinal para pacientes con lesión traumática de la médula espinal. La práctica de la inmovilización espinal sigue siendo controvertida con respecto a sus posibles beneficios o daños en pacientes con trauma. Se necesitan estudios comparativos para evaluar la seguridad de la inmovilización cervical y espinal. El objetivo de esta revisión es investigar si los sistemas actuales de inmovilización de un paciente traumatizado siguen siendo la mejor práctica en la atención de emergencia extrahospitalaria.</p></span>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1333 "Ancho" => 2091 "Tamanyo" => 141497 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Articles selection.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 966 "Ancho" => 1350 "Tamanyo" => 114979 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cervical collar, spine boards and strap.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 885 "Ancho" => 1255 "Tamanyo" => 83629 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Vacuum mattress.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 698 "Ancho" => 755 "Tamanyo" => 62456 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Kendrick extrication device – KED.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0120" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trauma systems around the world: a systematic overview" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 September | 3 | 2 | 5 |
| 2024 June | 1 | 0 | 1 |
| 2024 May | 1 | 0 | 1 |
| 2024 March | 1 | 0 | 1 |
| 2024 January | 2 | 0 | 2 |
| 2023 December | 2 | 0 | 2 |
| 2023 November | 5 | 2 | 7 |
| 2023 October | 5 | 0 | 5 |
| 2023 August | 55 | 6 | 61 |
| 2023 July | 104 | 9 | 113 |
| 2023 June | 55 | 5 | 60 |
| 2023 May | 44 | 41 | 85 |
