Patients with neurological deficits from suspected cervical spine injury should have a hard collar placed unless contraindicated
The practice of routinely placing a cervical spine collar on all trauma patients is being questioned. There are no randomised controlled trials demonstrating that cervical immobilisation prevents secondary spinal cord injury. In fact, there is a growing body of evidence that cervical spine collars may cause more harm in some patients.
The concerns regarding rigid cervical spine immobilisation are as follows1
- collars can restrict cranial venous outflow thus increasing ICP and worsening head injury outcomes
- collar placement and strict adherence to manual inline stabilisation can make advanced airway management more difficult and increase aspiration risk
- collars can worsen neurological deficits in some patients
- collars provide limited motion control
- collars can lead to pressure injuries even after a short period
- collars are uncomfortable and can increase cervical spine pain
St. Johns have recently adopted an algorithm to decide whether to place a cervical spine collar in the prehospital setting.
Patients may arrive to the ED with a lanyard around their neck stating that the cervical spine is not cleared.
ST JOHNS AMBULANCE CERVICAL SPINE IMMOBILISATION ALGORITHMsja c spine
From: SJA Clinical Procedures and Guidelines Comprehensive Edition (2016-2018)
Immobilisation of the patient in the ED
Where to proceed with these patients once they have arrived in the ED is unclear at this stage.
Some trauma patients can have their C spine cleared by using clinical decision rules2
Others will need to have imaging of their cervical spines and it will be up to the treating clinician and the institution to decide if these patients are going to require immobilisation to facilitate this.
If available in the ED, early application of a less rigid collar (eg: Aspen or Philadelphia) might be another immobilisation option for patients requiring further imaging.
It is suggested that departmental guidelines regarding this are discussed and formalised in conjunction with the radiology department.
- Sundstrøm T, Asbjørnsen H, Habiba S, Sunde GA, Wester K. Prehospital use of cervical collars in trauma patients: a critical review. J Neurotrauma. 2014;31(6):531-540.
- Stiell, Ian G., et al. “The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma.” New England Journal of Medicine26 (2003): 2510-2518.
About this guideline
Published: February 2018
Author: Emma Batistich
Approved by: Northern Region Trauma Network, ADHB, WDHB, CMDHB, NDHB
Review due: 2 years