There’s been a big discussion on cervical collars in trauma the recent years. We’ve covered the controversy here. Guidelines are usually slow to adapt, but now both national guidelines from the Netherlands and state guidelines from Queensland in Australia seems to be removing the hard collar from their guidelines, as we have in Bergen, Norway. And recently ILCOR has released a preliminary guideline on spinal stabilisation. They conclude that with current evidence, cervical collars can’t be recommended for routine application in trauma(!)
Cervical collar evidence
Scancrit having promoted a rethink of the use of cervical collars the recent years. As with many other areas in medicine, especially emergent settings, data is lacking.
Our belief is that we have to reach a conclusion on the data we’ve got. This is similar to how we have to make decisions on emergent patients without knowing the full story or background; You work with what you got, and adjust as you get new information. Too many guideline bodies walk away from that responsibility and end up with recommending nothing but more research urgently needed.
Still room for the cervical collar?
We all agree that the spine needs stabilisation and to be looked after when spine injuries suspected in trauma patients. In Bergen, Norway, we have removed the hard cervical collar from routine placement, only occasionally using it for extrication in unconscious patients where manual stabilisation is difficult or impossible.
So it was fantastic to see the ILCOR group, mostly known for their advice on cardiac emergencies, to come up with definitive advice on handling spinal stabilisation in trauma patients. This is a draft that might get changed down the road, but as it has been published online, we think the main conclusion will stay.
They were seeking to answer the question: “Among adults and children with suspected traumatic cervical spinal injury (P), does spinal motion restriction (I), compared with no spinal motion restriction (C), change neurological injury, complications, overall mortality, pain, patient comfort, movement of the spine, hospital length of stay (O)?”. Their answer was:
“We suggest against spinal motion restriction, defined as the reduction of or limitation of cervical spinal movement, by routine application of a cervical collar or bilateral sandbags (joined with 3-inch-wide cloth tape across the forehead) in comparison to no cervical spine restriction in adults and children with blunt suspected traumatic cervical spinal injury (weak recommendation, very low quality of evidence).
Values and preferences statement: Because of proven adverse effects in studies with injured patients, and evidence concerning a decrease in head movement only comes from studies with cadavers or healthy volunteers, benefits do not outweigh harms, and routine application of cervical collars is not recommended.”
Mind blown. We’ve been thinking this for a long time, but we never actually though an “official” body would come out and say it!
Please mind this is based on very low quality “evidence”, but this low quality evidence against the cervical collar seems to be stronger than any “evidence” possible to dig up FOR the cervical collar. Seems ILCOR agrees that the burden of evidence must rest on those who wants to implement a new treatment, as the cervical collar. Will there be proper trials? Ever? Interesting times.
Link to PDF of ILCOR Cervical Collar Guidelines DRAFT 2015
Web-link here: https://volunteer.heart.org/apps/pico/Pages/PublicComment.aspx?q=772