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Table 2 Summary of recommendations, quality of evidence and strength of recommendation

From: The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury

Recommendation Quality of evidence Strength of recommendation Rationale (Benefits, harms and the preferences of patients and clinicians)
1 Victims with potential spinal injury should have spinal stabilisation. Very low Strong Paucity of literature supporting spinal stabilisation. Very little literature documenting serious harm. Spinal cord injury can have devastating consequences. Potential benefits outweigh harms
2 A minimal handling strategy should be observed. Very low Strong Paucity of literature supporting spinal stabilisation. Very little literature documenting serious harm. Spinal cord injury can have devastating consequences. Potential benefits outweigh possible harms
3 Spinal stabilisation should never delay or preclude life-saving intervention in the critically injured trauma victim. Very low Good clinical practice Literature supporting this recommendation was considered too heterogenous for synthesis. The faculty finds that it is logical that spinal stabilisation in the critically injured patient may cause serious harm
4 Victims of isolated penetrating injury should not be immobilised. Moderate Strong One large study of moderate quality directly supports this recommendation. Spinal injury in patients with isolated penetrating injury is rare
5 Triaging tools based on clinical findings should be implemented. Moderate Strong Consistent evidence supporting triaging tools based on clinical findings rather than mechanism. No harmful effects documented
6 Cervical stabilisation may be achieved using manual in-line stabilisation, head-blocks, a rigid collar or combinations thereof. Very low Conditional Consistent experimental evidence demonstrating how rigid collars can stabilise the cervical spine. However, there is also evidence suggesting harm from rigid collars. No evidence proving superiority of any one method
7 Transfer from the ground or between stretchers should be achieved using a scoop stretcher. Very low Conditional General paucity of evidence. Some evidence for significant spinal motion during log-roll. Some evidence documenting improved stability with scoop stretcher transfers. Safety of scoop stretcher systems is good. No harmful effects documented
8 Patients with potential spinal injury should be transported strapped supine on a vacuum mattress or on an ambulance stretcher system. Very low Conditional Evidence supporting harm from hard surface stretcher systems. No consistent evidence demonstrating increased stability with any one method. Increased comfort associated with soft surface systems. No evidence exploring spinal stability of common stretcher systems
9 Hard surface stretcher systems may be used for transports of shorter duration only. Very low Conditional Evidence supporting harm from hard surface stretcher systems. No consistent evidence demonstrating increased stability with any one method. Increased comfort associated with soft surface systems
10 Patients should under some circumstances be invited to self-extricate from vehicles. Very low Conditional Two experimental studies demonstrating improved stability with self-extrication from vehicles. Reasonable and practical alternative as long as used cautiously