Exclusives, Patient Care, Trauma

Consensus Recommendations on the Prehospital Care of the Injured Athlete With a Suspected Catastrophic Cervical Spine Injury

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By Brianna M. Mills, MA, PhD*; Kelsey M. Conrick, MPH†; Scott Anderson, ATC‡; Julian Bailes, MD§; Barry P. Boden, MD||; Darryl Conway, MA, AT, ATC¶; James Ellis, MD, FACEP#; Francis Feld, DNP, CRNA, LAT, NRP**; Murphy Grant, MS, ATC, CES, PES††; Brian Hainline, MD‡‡; Glenn Henry, MA, EMT-P§§; Stanley A. Herring, MD, FACSM, FAMSSM||||; Wellington K. Hsu, MD¶¶; Alex Isakov, MD, MPH, FAEMS##; Tory R. Lindley, MA, ATC***; Lance McNamara, MS, ATC, EMT-I†††; Jason P. Mihalik, PhD, CAT(C), ATC, FACSM‡‡‡; Timothy L. Neal, MS, AT, ATC, CCISM§§§; Margot Putukian, MD, FACSM, FAMSSM||||||; Frederick P. Rivara, MD, MPH¶¶¶ Allen K. Sills, MD, FACS###; Erik E. Swartz, PhD, ATC, FNATA****; Monica S. Vavilala, MD††††; Ron Courson, ATC, PT, NRAEMT, CSCS‡‡‡‡

*Harborview Injury Prevention and Research Center, University of Washington, Seattle; †Harborview Injury Prevention and Research Center and School of Social Work, University of Washington, Seattle; ‡University of Oklahoma, Norman; §NorthShore University Health System, Evanston, IL; ||The Orthopaedic Center, A Division of CAO, Rockville, MD; ¶University of Michigan Athletic Medicine, Ann Arbor; #University of South Carolina School of Medicine, Greenville; **University of Pittsburgh Medical Center, PA; ††Wake Forest University, Winston-Salem, NC; ‡‡Sports Science Institute, National Collegiate Athletic Association, Indianapolis, IN; §§Athens Technical College, Watkinsville, GA; ||||Department of Rehabilitation Medicine and The Sports Institute, University of Washington, Seattle; ¶¶Northwestern University Feinberg School of Medicine, Chicago, IL; ##Section of Prehospital and Disaster Medicine, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA; ***Northwestern University, Evanston, IL; †††Barrow County Schools, Winder-Barrow High School, Winder, GA; ‡‡‡Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill; §§§Concordia University, Ann Arbor, MI; ||||||University Health Services, Rutgers Robert Wood Johnson Medical School, Princeton, NJ; ¶¶¶Harborview Injury Prevention and Research Center and Department of Pediatrics, University of Washington and Seattle Children’s Hospital, WA; ###National Football League, New York, NY, Vanderbilt University Medical Center, Nashville, TN; ****University of Massachusetts, Lowell; ††††Harborview Injury Prevention and Research Center, Department of Pediatrics, and Department of Anesthesiology, University of Washington, Seattle; ‡‡‡‡University of Georgia, Athens

Editor’s note: This article is being published simultaneously in the Journal of Athletic Training and the Clinical Journal of Sport Medicine.

Introduction: Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs.

Methods: A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers’ Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2-day nominal group technique meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review.

Results: The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the nominal group technique meeting created and refined conclusions and recommendations until consensus was achieved.

Conclusions: These conclusions and recommendations represent a pragmatic approach, balancing expert experiences
and the available scientific evidence.