Aims and Objectives Pre-hospital spinal immobilisation is generally recommended for traumatic injury in numerous guidelines and has been adopted worldwide by many pre-hospital medical services. However, there is growing concern that full cervical spinal immobilisation during pre-hospital and emergency care may cause more harm than benefit.

This systematic review investigated whether different cervical spine immobilisation strategies (full immobilisation, movement minimisation or no immobilisation), impact neurological and/or other outcomes for patients with suspected cervical spinal injury in the pre-hospital and emergency department setting.

Method and Design Several electronic databases and research registers were systematically searched until September 2023. All comparative studies that examined the potential benefits and/or harms of immobilisation practices during pre-hospital and emergency care of patients with a possible cervical spine injury (pre-imaging) following blunt trauma were included. Two authors independently selected and extracted data. Risk of bias was appraised using the Cochrane ROBINS-I tool for non-randomised studies. Data were synthesised narratively.

Results and Conclusion Of the 1811 citations identified, six observational studies met the inclusion criteria (two prospective and four retrospective studies; n=8207 participants in total). The methodological quality was variable, with most studies having serious or critical risk of bias. The effect of cervical spine immobilisation practices such as full immobilisation or movement minimisation during pre-hospital and emergency care did not show clear evidence of benefit for the prevention of neurological deterioration, spinal injuries, and death compared with no immobilisation. However, increased pain, discomfort and anatomical complications were associated with collar application during immobilisation.

Despite the limited evidence, available data suggests that pre-hospital cervical spine immobilisation (full immobilisation or movement minimisation) was of uncertain value due to the lack of demonstrable benefit and may lead to potential complications and adverse outcomes. High-quality randomised comparative studies are urgently required to address this important question.