Note from Dr. Mell: While the evidence is weak, it seems that oral CE liquids are superior to water alone for the rehydration of individuals with simple exercise-induced dehydration. Sports drinks may have value.

Spinal Motion Restriction (FA 772)

Recommendation Author: Jonathan Thorndike, MD

Dr. Thorndike is a member of the emergency medicine residency training class of 2019 at the Warren Alpert Medical School of Brown University.

Question: Among adults and children with suspected cervical trauma (P), does spinal motion restriction (I) compared to no spinal restriction (C) improve outcomes or reduce complications (O)?

Results: A total of 25 nonrandomized studies that addressed the PICO question were included in the analysis. All studies were observational and deemed to be low- to very-low-quality evidence. Methodology ranged from convenience samples of healthy volunteers to large retrospective reviews.

Outcomes: One observational study showed no difference in neurological injury between patients treated with cervical collars and those without, but analysis was incomplete due to nonpublished intervention and control group means and standard deviations. One small study showed no difference in patient comfort between the two groups. Regarding complications, studies suggest that c-collars cause increased intracranial pressure but no decrease in tidal volume. One pediatric study showed no limitation of spine movement by c-collars, although 13 nonpediatric studies demonstrated movement limitation. There was no evidence to address the outcomes of overall mortality, pain, or hospital length of stay for soft, semi-rigid collars or sandbags.

Discussion: C-collars are effective at reducing spine motion, but for first-aid providers, the risks of complications such as unnecessary neck motion or increased intracranial pressure outweigh the benefit of attempting placement. It may be difficult for first-aid providers to determine which patients are at high risk for spinal injury and thus who could benefit the most from immobilization.

Recommendation: The task force recommends against the routine application of cervical collars by first-aid providers.

Note from Dr. Smith: First responders should focus on reducing cervical spinal movement in trauma rather than applying devices to restrict spine movement. Although not part of the review, there is also potential value in manual cervical stabilization in certain circumstances.