Authors (including presenting author) :
Yeung JHH(1) Choi SH(2), Tse B(2), Li WY(1) , Yeung N (1), Ng WK(3)
Affiliation :
(1) Accident and Emergency (A&E) Department, (2) Department of Orthopedic and Traumatology, (3) Department of Surgery, Princes of Margaret Hospital (PMH)
Introduction :
In Hong Kong, trauma patients with significant impact are usually spinal immobilized (SI) by a hard spinal board (SB). Studies demonstrated that SB not only provided no support to the physiological lumber lordosis but also induced pain, pressure injury, higher risk of aspiration and respiratory compromise. It may hinder the patient’s physical exam and resulting in unnecessary radiographs. Besides, there have never been a study demonstrated the effectiveness of SB in preventing spinal cord injury. Due to increasing reports about disadvantages of SB, there is a shift from SI to spinal motion restriction (SMR) by early removal of SB.
Objectives :
To promote evidence based practice (EBP) by (i) to develop a guideline that supports decision-making for early removal of spinal board (ii) to determine if the guideline and training have an effect on reduction of the time of patient be immobilized on SB.
Methodology :
The concept on early removal of SB was support by PMH Trauma Review Committee and promoted. Guidelines on early removal of SB was issued in PMH on 25 Apr 2022. Training on how to remove SB during logroll and transfer of patient from trauma bed to CT table or hospital bed were provided to both nursing and medical staff. Observational study was done in PMH trauma center A&E which seeing 100, 000 patients per year. Before the SB guideline was issue, the earliest time of removal SB was at the time of the patients admitted to ward and some needed to wait until CT report available. After the SB guideline effective, the SB was generally removed after log roll in A&E. For all trauma cases admitted to trauma room with SB, A&E nurses recorded the time of SB removal for comparison. Data was collected form 1 May 2022 to 31 Dec 2022.
Result & Outcome :
There were total 435 patients admitted to A&E trauma room in the study period. 159(37%) were on SB, 113(71%) of them were male patients. Age ranged from 6 to 90 years and the mean age was 49 years. ISS range from 1 to 75, 21 patients with ISS>15. 143 (90%) had SB removed in A&E and the compliance rate increased from 65% on May to 100% from Oct onward. The average time of A&E SB time was 22 minutes. The average time of A&E to hospital admission time of this group of patient was 82 minutes. In average, this EBP successfully reduced at least 60mins SB time on each patient. Conclusion: The promotion of EBP, set up clinical guideline, education and training on early removal of SB can significantly reduce the time trauma patients be immobilized in a hard SB. It minimized the potential risks, pain and discomfort due to SB.
