Backboard versus mattress splint immobilization: A comparison of symptoms generated

doi:10.1016/0736-4679(96)00034-0

The Journal of Emergency Medicine

Volume 14, Issue 3, May–June 1996, Pages 293-298

https://doi.org/10.1016/0736-4679(96)00034-0 Get rights and content

Abstract

The study objective was to compare spinal immobilization techniques to a vacuum mattress-splint (VMS) with respect to the incidence of symptoms generated by the immobilization process. We used a prospective, cross-over study in a university hospital setting. Participants consisted of 37 healthy volunteers without history of back pain or spinal disease.

Interventions consisted of two phases. In Phase I, subjects were randomly assigned to be immobilized on either a wooden backboard or a mattress-splint for 30 min. The incidence and severity of any symptoms generated by the immobilization process were recorded. In Phase II, the two groups were again tested after a 2-week washout period, with the method of immobilization being reversed. Symptoms and severity were again recorded.

Pain symptoms were confined to four anatomic sites: Occipital prominence, lumbosacral spine, scapulae, and cervical spine. After adjusting for the effect of order of exposure, subjects were 3.08 times more likely to have symptoms when immobilized on a backboard than when immobilized on the VMS. They were 7.88 times more likely to complain of occipital pain and 4.27 times more likely to complain of lumbosacral pain. Severity of occipital and lumbosacral pain was also significantly greater during backboard immobilization.

We conclude that, when compared to a VMS, standard backboard immobilization appears to be associated with an increased incidence of symptoms in general and an increased incidence and severity of occipital and lumbosacral pain in particular.

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Current guidelines dictate the use of SB’s despite the availability of a possible alternative. The use of a SB is associated with high levels of patient pain and discomfort [1,2,4,5], a significant risk of pressure ulcer development (estimates of up to 30.6%) [3], and has been previously shown to offer no support to the lumbar spine due to its flat and rigid surface [6,7]. The VMS has been previously demonstrated to provide more comfort and produce less pain in splinted subjects [2,4,5], to conform and support the lumbar lordosis of the spine [6,7], and to provide equivalent, if not better immobilization with or without the use of a cervical collar [2,5].
Most emergency transport protocols in the United States currently call for the use of a spine board (SB) to help immobilize the trauma patient. However, there are concerns that their use is associated with a risk of pressure ulcer development. An alternative device, the vacuum mattress splint (VMS) has been shown by previous investigations to be a viable alternative to the SB, but no single study has explicated the tissue-interface pressure in depth.
To determine if the VMS will exert less pressure on areas of the body susceptible to pressure ulcers than a SB we enrolled healthy subjects to lie on the devices in random order while pressure measurements were recorded. Sensors were placed underneath the occiput, scapulae, sacrum, and heels of each subject lying on each device. Three parameters were used to analyze differences between the two devices: 1) mean pressure of all active cells, 2) number of cells exceeding 9.3 kPa, and 3) maximal pressure (P_max).
In all regions, there was significant reduction in the mean pressure of all active cells in the VMS. In the number of cells exceeding 9.3 kPa, we saw a significant reduction in the sacrum and scapulae in the VMS, no difference in the occiput, and significantly more cells above this value in the heels of subjects on the VMS. P_max was significantly reduced in all regions, and was less than half when examining the sacrum (104.3 vs. 41.8 kPa, p < 0.001).
This study does not exclude the possibility of pressure ulcer development in the VMS although there was a significant reduction in pressure in the parameters we measured in most areas. These results indicate that the VMS may reduce the incidence and severity of pressure ulcer development compared to the SB. Further prospective trials are needed to determine if these results will translate into better clinical outcomes.

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Original contributionBackboard versus mattress splint immobilization: A comparison of symptoms generated

Abstract

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Catalog No. 1032

Association between pressure sores and immobilization in the immediate post-injury period

Orthopedics

Risk factors for early occurring pressure ulcers following spinal cord injury

Am J Phys Med Rehab

Original contribution
Backboard versus mattress splint immobilization: A comparison of symptoms generated