July 2023 Pick of the Month

Times Are Always Changing, Sometimes for the Better

Somewhere in a metaphorical, dark and forlorn valley, buried in unmarked graves, lie the dogmas of trauma that finally died the deaths they deserved. Research and common sense vanquished the policy of leaving patients on backboards for hours until their spines were “cleared.” Sir Godfrey Hounsfield’s invention wiped out the mandatory nasogastric tube and Foley catheter that were required in the era of diagnostic peritoneal lavages. And blessings to whatever force caused the useless and inane rectal exam to be replaced by the butt cheek clench. Perhaps, someday, these historical counterfactuals will be joined by their often useless and sometimes fiendish friend, the cervical collar. 

In the aptly titled Patterns of change in prehospital spinal motion restriction: A retrospective database review, McDonald et al. assessed the prehospital use of cervical immobilization and use of backboards from 2009 to 2019 in Winnipeg, Canada. They found a marked decrease in the combination (from 31% to 12%) that was not explained by protocol changes, but appears to be part of a secular trend, especially with more minor mechanisms of trauma. Perhaps with experience and evidence, patients, first responders and emergency physicians have collectively, if implicitly, begun to recognize that prehospital trauma care can be personalized, rather than driven by normative behavior and dogma.

More work needs to be done to determine if these trends are trading off safety in exchange for greater patient comfort, but the data show a clear trend in behavior. It is reasonable to hypothesize that this change would be welcomed by virtually all of the thousands of conscious and alert patients who are suffering through a cervical collar at this moment in EDs around the world.

Jeffrey A. Kline, MD
Editor-in-Chief