Roya Habibi Arejan1,2, Mohammad Hossein Asgardoon1,3, Maryam Shabany1,4, Zahra Ghodsi1, Hamid Reza Dehghan5, Masoud Sohrabi Asl1, Hamidreza Ostadrahimi6, Alex R Vaccaro7, Vafa Rahimi-Movaghar8,9,10,11,12,13. 1. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2. Rehabilitation Office, State Welfare Organization of Iran, Tehran, Iran. 3. Iranian Student Society for Immunodeficiencies, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran. 4. Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. 5. Research Center for Health Technology Assessment and Medical Informatics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 6. Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran. 7. Department of Orthopedics and Neurosurgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA. 8. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. V_rahimi@sina.tums.ac.ir. 9. Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. V_rahimi@sina.tums.ac.ir. 10. Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. V_rahimi@sina.tums.ac.ir. 11. Universal Scientific Education and Research Network (USERN), Tehran, Iran. V_rahimi@sina.tums.ac.ir. 12. Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran. V_rahimi@sina.tums.ac.ir. 13. Spine Program, University of Toronto, Toronto, ON, Canada. V_rahimi@sina.tums.ac.ir.
Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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