Elsevier

Injury

Volume 45, Issue 11, November 2014, Pages 1741-1746
Injury

Effects of unconsciousness during spinal immobilization on tissue-interface pressures: A randomized controlled trial comparing a standard rigid spineboard with a newly developed soft-layered long spineboard

https://doi.org/10.1016/j.injury.2014.06.006Get rights and content

Abstract

Background

Immobilization of the spine of patients with trauma at risk of spinal damage is usually performed using a rigid long spineboard or vacuum mattress, both during prehospital and in-hospital care. However, disadvantages of these immobilization devices in terms of discomfort and tissue-interface pressures have guided the development of soft-layered long spineboards. We compared tissue-interface pressures between awake and anaesthetized (unconscious) patients during immobilization on a rigid spineboard and a soft-layered long spineboard.

Methods

In this comparative study, 30 anaesthetized patients were randomized to immobilization on either the rigid spineboard or the soft-layered spineboard for the duration of their elective surgery. Tissue-interface pressures measured using an Xsensor pressure-mapping device were compared with those of 30 healthy volunteers who were immobilized sequentially on the rigid spineboard and the soft-layered spineboard. Redness of the sacrum was also recorded for the anaesthetized patients immediately after the surgery.

Results

For both anaesthetized patients and awake volunteers, tissue-interface pressures were significantly lower on the soft-layered spineboard than on the rigid spineboard, both at start and after 15 min. On the soft-layered spineboard, tissue interface pressure and peak pressure index (PPI) for the sacrum were significantly lower for anaesthetized patients than for awake volunteers. Peak pressures and PPI on the rigid spineboard were equal for both groups. Tissue-interface pressures did not change significantly over time. Redness of the sacrum was significantly more pronounced on the rigid spineboard than on the soft-layered spineboard.

Conclusions

This prospective randomized controlled trial shows that using a soft-layered spineboard compared to a rigid spineboard for spinal immobilization resulted in lower tissue-interface pressures in both awake volunteers and anaesthetized patients. Moreover, tissue-interface pressures on the soft-layered spineboard were lower in anaesthetized patients than in awake volunteers. These findings show the importance of using a soft-layered spineboard to reduce tissue-interface pressure, especially for patients who cannot relieve pressure themselves by changing position.

Section snippets

Background

Spinal immobilization with long spineboards and cervical collars for extrication and transfer of trauma patients is a standard precaution in both prehospital and in-hospital protocols [1]. Especially for unconscious trauma patients, who are unable to maintain spinal alignment by muscular tone, these methods are considered essential to protect the spine from further injury.

Although there is a general consensus that the patient should be removed from the spineboard as soon as reasonably possible,

Study design

We conducted a prospective, randomized, single-blinded, comparative study on tissue-interface pressures and redness of the skin using a standard rigid long spineboard and a soft-layered long spineboard in patients undergoing surgery under general anaesthesia. Tissue interface pressures were compared with those of a group of awake healthy volunteers. The study has been assigned ISRCTN96064657.

Recruitment of participants

A sample of 30 patients (25 men and 5 women) was recruited at the outpatient department of the

Patients

Characteristics of anaesthetized subjects and awake controls are described in Table 1. No differences in demographics or baseline characteristics were found between the patients randomized for rigid spineboard or soft-layered spineboard. Participants in the patient group were on average older and more often male than in the awake volunteers group. No relationship was found between pressure values and age or gender.

Tissue-interface pressures

In both awake volunteers and anaesthetized patients, peak pressures for scapula

Discussion

This study showed that unconscious subjects placed on a soft-layered spine board had lower tissue-interface pressures than conscious subjects, while no differences between these two groups were found when using a rigid spine board. Patients under anaesthesia and awake controls both had significantly lower tissue-interface pressures on the soft-layered spineboard than on the rigid spineboard.

Despite a growing body of evidence that immobilizing patients on a rigid spineboard can cause a number of

Conflict of interest

The authors state there are no conflicts of interest. No external funding was received for this study.

References (32)

  • American College of Surgeons Committee on Trauma

    Advanced Trauma Life Support for doctors, Chicago, IL

    (2008)
  • D.R. Cooney et al.

    Backboard time for patients receiving spinal immobilization by emergency medical services

    Int J Emerg Med

    (2013)
  • R.M. Allman et al.

    Pressure ulcers, hospital complications, and disease severity: impact on hospital costs and length of stay

    Adv Skin Wound Care

    (1999)
  • K.M. Baldwin et al.

    Pressure ulcer risk following critical traumatic injury

    Adv Skin Wound Care

    (1998)
  • C. Dealey et al.

    The cost of pressure ulcers in the United Kingdom

    J Wound Care

    (2012)
  • N. Graves et al.

    Modeling the economic losses from pressure ulcers among hospitalized patients in Australia

    Wound Repair Regen

    (2005)
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