Long Spine Boards

It always seems that when you are busy someone is asking to clear a patient off a long spine board (backboard). What are the reasons behind this.

THE DECUBITUS ULCER

From a review in 2011 “None of the studies assessed time on hard board and the clinical outcome of pressure sores. As a result, there is no firm time point cited in the literature after which immobilization should be discontinued.” After going back and reviewing the articles the evidence is scarce, mostly involving paralyzed patients and the sample sizes are small. In a frequently cited study the patients were not examined for a pressure ulcer until 24-72 hours after admission. Other study observations of a stage I decubitus afer being removed from a board in the ED is much different then progressing to true skin breakdown later in the hospital course (outcome was not followed). No good randomized controls seem to be present.

PAIN

Many patients report that being on a spine board is “very painful” and in healthy volunteers 50% had moderate to severe pain as soon as 30 minutes after immobilization. Padding the spine board decreases pain without compromising spine stability.

SUGGESTIONS

For long transports/transfers padded boards should be utilized if possible to reduce pressure on the occiput and sacrum and decrease discomfort. Patients should be moved as rapidly and safely as possible off spine boards. Being immobilized for a short amount of extra time will not likely result in skin breakdown although an angry patient in pain may be waiting for you.

Ahn H, et al. Pre-hospital care management of a potential spinal cord injured patient: a systematic review of the literature and evidence-based guidelines. J Neurotrauma. 2011 Aug;28(8):1341-61.

Cordell WH, et al. Pain and tissue-interface pressures during spine-board immobilization. Ann Emerg Med. 1995 Jul;26(1):31-6.

Mawson AR, et al. Risk factors for early occurring pressure ulcers following spinal cord injury. Am J Phys Med Rehabil. 1988 Jun;67(3):123-7.