Management of Trauma Patient on Backboard Awaiting Imaging

Rationale for Immediate Backboard Removal

Prolonged immobilization on a backboard beyond 2 hours causes significant morbidity, and the patient should be transferred to a padded surface while maintaining cervical collar and spinal precautions until imaging is complete, as recommended by the Intensive Care Medicine guidelines 1, 2
The complications of prolonged backboard immobilization include pressure sores, with an estimated treatment cost of approximately $30,000, and increased intracranial pressure, worsened by cervical collars raising ICP by 4.69 mm Hg 2
Ventilator-associated pneumonia is a risk, with attributable mortality approaching 6%, according to the Intensive Care Medicine guidelines 1, 3
Thromboembolic events are also a risk of prolonged backboard immobilization 4

The patient should be logrolled off the backboard onto a padded surface using spinal precautions, and transferred to a padded bed or stretcher, as recommended by the Intensive Care Medicine guidelines 1

The American College of Radiology recommends that cervical collars remain until the spine is cleared by appropriate imaging, with a sensitivity and negative predictive value of modern multidetector CT approaching 99.6% and 99.9% respectively when properly performed 5, 4
For obtunded or high-risk patients, modern multidetector CT with <3mm slice thickness is the primary screening modality, according to the Journal of the American College of Radiology guidelines 5