Mitchnik Ilan Y, Ezra Yael V, Radomislensky Irina, Talmy Tomer, Ankory Ran, Benov Avi, Gelikas Shaul
Medical Corps, Israel Defense Force, Tel HaShomer, Tel Aviv 5510802, Israel.
Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190500, Israel.
J Clin Med. 2024 Aug 18;13(16):4868. doi: 10.3390/jcm13164868.
Cervical spine (C-spine) trauma usually results from blunt injuries and is traditionally managed by prehospital spinal immobilization using a cervical collar. We sought to examine if prehospital C-spine immobilization is associated with actual C-spine injuries and what factors are associated with the decision to immobilize the C-spine. We retrospectively analyzed blunt trauma patients treated by Israeli Defense Force (IDF) medical teams from 2015 to 2020. Children, penetrating injuries, and non-threatening injuries were excluded. Demographic data, injury characteristics, and prehospital information were collected from the IDF Trauma Registry's electronic medical records and merged with corresponding hospital data from the Israeli National Trauma Registry. Overall, 220 patients were included, with a mean age of 32 and a predominance of male patients (78%). Most injuries were due to motor vehicle collisions (77%). In total, 40% of the patients received a cervical collar. C-spine injuries were present in 8%, of which 50% were immobilized with a cervical collar. There were no significant differences in the incidences of C-spine injuries or disability outcomes with or without collar immobilization. The use of a collar was significantly associated with backboard immobilization (OR = 14.5, < 0.001) and oxygen use (OR = 2.5, = 0.032). Prehospital C-spine immobilization was not associated with C-spine injury or neurological disability incidences. C-spine immobilization by medical providers may be influenced by factors other than the suspected presence of a C-spine injury, such as the use of a backboard. Clear clinical guidelines for inexperienced medical providers are called for.
颈椎（C 型脊柱）创伤通常由钝性损伤引起，传统上通过在院前使用颈托进行脊柱固定来处理。我们试图研究院前 C 型脊柱固定是否与实际的 C 型脊柱损伤相关，以及哪些因素与决定固定 C 型脊柱有关。我们回顾性分析了 2015 年至 2020 年期间由以色列国防军（IDF）医疗队治疗的钝性创伤患者。儿童、穿透性损伤和无威胁性损伤被排除在外。人口统计学数据、损伤特征和院前信息从 IDF 创伤登记处的电子病历中收集，并与以色列国家创伤登记处的相应医院数据合并。总体而言，纳入了 220 名患者，平均年龄为 32 岁，男性患者占多数（78%）。大多数损伤是由于机动车碰撞（77%）。总共有 40%的患者使用了颈托。C 型脊柱损伤的发生率为 8%，其中 50%使用颈托固定。有无颈托固定在 C 型脊柱损伤发生率或残疾结局方面没有显著差异。使用颈托与使用背板固定（OR = 14.5，< 0.001）和使用氧气（OR = 2.5， = 0.032）显著相关。院前 C 型脊柱固定与 C 型脊柱损伤或神经功能残疾发生率无关。医疗人员进行的 C 型脊柱固定可能受到疑似 C 型脊柱损伤以外的因素影响，例如使用背板。需要为经验不足的医疗人员制定明确的临床指南。
