Baylor College of Medicine: applying neck brace for a trauma patient, standard procedure for many decades, can worsen the injury and lead to severe paralysis or death

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Baylor study doubts neck brace standard

In some cases, device might hurt accident victims

By TODD ACKERMAN

Copyright 2010 Houston Chronicle

Jan. 23, 2010, 10:48AM

Applying a brace to the neck of a trauma patient, standard procedure for

many decades, can worsen the injury and lead to severe paralysis or death,

according to a new study by Houston researchers.

Baylor College of Medicine doctors used cadavers to confirm that so-called

cervical collars can be counterproductive, a finding that could upturn the

way emergency medical personnel and doctors act to stabilize and protect the

upper spine in potentially fatal neck injuries, such as those that commonly

occur in bad automobile accidents.

" This study is a proof of concept that in cases of severely unstable neck

injuries, cervical collars are not only not helpful, but harmful in many

situations, " said Dr. Peleg Ben-Galim, a professor of orthopedic surgery and

the study's lead author. " More research needs to be done, but it might be

that we can prevent some of the deaths and quadriplegia that occur in these

injuries. "

The study appeared this week in the Journal of Trauma.

Dr. Persse, medical director of Houston's Emergency Management

Services, called the study " compelling " and " concerning " and said it will

come up for discussion at the annual meeting of the nation's 30 largest EMS

departments in Dallas next month. But he also said he doesn't want to

overreact.

" We need to look at this thoughtfully before we change the standard of

care, " said Persse. " It concerned a particular kind of injury. It may apply

to other injuries as well, but we don't know that yet. "

But Persse added that he understands the need to act quickly, that " it's not

like a lot of areas where there's not as serious downside to waiting for the

next study. "

Car-crash victims

Ben-Galim said cervical spine injuries are found in the autopsies of up to

94 percent of people who die in car crashes, which claim about 44,000 U.S.

lives annually. There are about 11,000 people annually who survive spinal

cord injuries.

There is no obvious alternative to cervical collars, though hospitals often

place sandbags under the back of the patient's head and, less commonly, some

EMS teams at the scene of the crash wedge the head of the patient between

foam bolsters on the backboard.

The injuries in question involve the area where the brain connects to the

spinal cord. Doctors treating such injuries work to stabilize the ligaments,

muscle and bone to prevent secondary injury and to protect the brain stem

and cord.

Baylor researchers undertook the study after a case in which a broken jaw

precluded the use of a cervical collar on the survivor of a car wreck

brought to Ben Taub. When the doctors started to put a collar on the

patient, fluoroscopy showed two of the patient's vertebrae separate, causing

doctors to immediately remove the collar. The treated patient ultimately

walked out of the hospital on his own.

Ben-Galim noted that there are other such case histories in medical

literature.

To study the phenomenon, Baylor researchers made an incision in cadaver neck

ligaments based on patient X-rays, then simulated clinical scenarios by

applying cervical collars and putting the bodies in ambulances and driving a

distance.

In all of the cadavers, imaging technologies found that the collar increased

the rupture.

In effect, the collars pushed the head away from the shoulders, Ben-Galim

said.

He said the rupture stretching occurs because of both the application of the

collars and their continued use.

One national expert called the study interesting but said he wasn't sure it

would one day change the standard of care.

" There are certain cases, like the ones in this study, that can be

dangerous, but they're rare - most people who suffer high neck injuries die

immediately, " said Dr. Tom Scaletta, the past president of the American

Academy of Emergency Medicine. " I think the study's importance will be to

raise awareness about the special care that must be taken - preserving

patients' normal head position, making sure they're not having difficulty

breathing. "

Anecdotal cases

Dr. Walter Lowe, director of the Memorial Hermann Sports Medicine Institute

and team physician for the Houston Texans football team, said the study

wouldn't change the care of injured football players removed from the field

in collars and on stretchers because those injuries tend to involve lower

areas of the spine.

Ben-Galim said that since the study was undertaken, Ben Taub doctors have

saved patients with severe neck injuries by loosening or removing cervical

collars early and rushing them to the operating room, but he acknowledged

such cases are anecdotal.

He said the research team looked at 400 articles and found no scientific

evidence that cervical collars can stabilize severely unstabilized spine

injuries.