SOFTLY: Comparison of patient-reported discomfort of rigid versus soft collar during ED investigation for potential cervical spine injury in low-risk blunt trauma patients

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Most traumatic spinal cord injuries (e.g. resulting in paraplegia and quadriplegia) happen at the time of the injury. A very small number might, in theory, be caused when an unstable fracture of the neck bones moves, injuring the spinal cord (delayed spinal cord injury). To address this risk, it is common for ambulance services and emergency departments to place patients who they think might have an injury to the bones of their neck (cervical spine) in a protective collar. The aim is to minimise neck movement until imaging (x-rays or CT scans) can be performed. The rationale is that if there is a fracture of the neck bones, neck movement could cause the bone fragments to move resulting in damage to the spinal cord. Historically, rigid neck collars have been, and are, used. There is however no high-quality research data showing clear benefit of this approach. This practice is now being questioned. Delayed spinal cord injury is an extremely rare event, there is no evidence that rigid collars prevent it and there is growing evidence of harm caused by rigid neck collars. This includes skin damage due to the pressure they apply, the risk of inhaling food or fluids when trying to eat or drink (aspiration) and damage to nerves in the neck. Anecdotally, patients report significant pain/discomfort and that eating or drinking is difficult. A proportion of patients are not able to tolerate the collar and remove it or loosen it such that it is ineffective. Some bodies have recommended a more selective strategy for limiting neck movement, including Norwegian and Danish guidelines and the Queensland Ambulance Service. This study aims, in a prospective study, to compare use of a rigid collar (as is current practice) against the application of a soft, foam collar with an emphasis on patients’ experience – in particular the amount of discomfort experienced – as well as clinical outcomes including pressure injuries and choking (aspiration) events.