Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Rehabilitation Office, State Welfare Organization of Iran, Tehran, Iran.
Eur Spine J. 2022 May;31(5):1309-1329. doi: 10.1007/s00586-022-07164-4. Epub 2022 Mar 21.
To gain insight into current research regarding prehospital care (PHC) in patients with potential traumatic spinal cord injury (TSCI) and to disseminate the findings to the research community.
In March 2019, we performed a literature search of publications from January 1990 to March 2019 indexed in PubMed, gray literature including professional websites; and reference sections of selected articles for other relevant literature. This review was performed according to Arksey and O'Malley's framework.
There were 42 studies selected based on the inclusion criteria for review; 18 articles regarding immobilization; 12 articles regarding movement, positioning and transport; four for spinal clearance; three for airway protection; and two for the role of PHC providers. There were some articles that covered two topics: one article was regarding movement, positioning and transport and airway protection, and two were regarding spinal clearance and the role of PHC providers.
There was no uniform opinion about spinal immobilization of patients with suspected TSCI. The novel lateral trauma position and one of two High Arm IN Endangered Spine (HAINES) methods are preferred methods for unconscious patients. Controlled self-extrication for patients with stable hemodynamic status is recommended. Early and proper identifying of potential TSCI by PHC providers can significantly improve patients' outcomes and can result in avoiding unwanted spinal immobilization. Future prospective studies with a large sample size in real-life settings are needed to provide clear and evidence-based data in PHC of patients with suspected TSCI.
深入了解目前有关潜在创伤性脊髓损伤（TSCI）患者的院前急救（PHC）研究，并将研究结果传播给研究界。
2019 年 3 月，我们对 1990 年 1 月至 2019 年 3 月在 PubMed 索引的出版物、包括专业网站在内的灰色文献以及选定文章的参考文献部分进行了文献检索，以查找其他相关文献。该综述是根据 Arksey 和 O'Malley 的框架进行的。
根据综述的纳入标准，共选择了 42 项研究；18 篇关于固定的文章；12 篇关于运动、定位和运输的文章；4 篇关于脊柱清除的文章；3 篇关于气道保护的文章；2 篇关于 PHC 提供者作用的文章。有些文章涵盖了两个主题：一篇文章是关于运动、定位和运输以及气道保护，两篇文章是关于脊柱清除和 PHC 提供者的作用。
对于疑似 TSCI 患者的脊柱固定，没有统一的意见。对于无意识患者，新型侧位创伤位和两种高位上肢 IN 濒危脊柱（HAINES）方法之一是首选方法。对于血流动力学稳定的患者，建议进行早期和适当的潜在 TSCI 识别。PHC 提供者早期和正确识别潜在的 TSCI 可以显著改善患者的预后，并避免不必要的脊柱固定。需要在现实环境中进行未来的前瞻性研究，以提供有关疑似 TSCI 患者 PHC 的清晰和基于证据的数据。
