Cost-utility analysis of prehospital spine immobilization recommendations for penetrating trauma

Garcia, Arturo; Liu, Terrence H.; Victorino, Gregory P.

doi:10.1097/ta.0b013e3182aafe50

Cited by 14 publications

(10 citation statements)

References 33 publications

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“…The studies included in the review did not consistently use the recommended societal perspective for accounting for costs, use multiple resource utilization categories, use constant dollars, discount future costs and outcomes, use a lifetime horizon, or include an indication of uncertainty in results using 95% confidence or uncertainty intervals (Table 2). Garcia, Liu, & Victorino (2014) and Freedberg et al (2006) incorporated the most guideline recommendations in their studies compared to other studies included in the review.…”

Section: Resultsmentioning

confidence: 99%

Quantity and Quality of Economic Evaluations in U.S. Nursing Research, 1997–2015

et al. 2017

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Background The United States has a complex healthcare system that is undergoing substantial reformations. There is a need for high-quality, economic evaluations of nursing practice. An updated review of completed economic evaluations relevant to the field of nursing within the U.S. healthcare system is timely and needed. Objectives The purpose of this study was to evaluate and describe the quantity and quality of economic evaluations in nursing-relevant research performed in the U.S. between 1997 and 2015. Methods Four databases were searched. Titles, abstracts, and full-text content were reviewed to identify studies that analyzed both costs and outcomes, relevant to nursing, performed in the U.S., and used the quality-adjusted life year (QALY) to measure effectiveness. For included studies, data were extracted from full-text articles using criteria from U.S. Public Health Service’s Panel on Cost-Effectiveness in Health and Medicine. Results Twenty-eight studies met the inclusion criteria. Most (n = 25, 89%) were published in the last decade of the analysis, from 2006 to 2015. Assessment of quality, based on selected items from the panel guidelines, found that the evaluations did not consistently use the recommended societal perspective, use multiple resource utilization categories, use constant dollars, discount future costs and outcomes, use a lifetime horizon, or include an indication of uncertainty in results. The only resource utilization category consistently included across studies was healthcare resources. Discussion Only 28 nursing-related studies meeting the inclusion criteria were identified as meeting robust health economic evaluation methodological criteria, and most did not include all important guideline items. Despite increases in absolute numbers of published studies over the past decade, economic evaluation has been underutilized in U.S. nursing-relevant research in the past two decades.

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Section: Resultsmentioning

confidence: 99%

Quantity and Quality of Economic Evaluations in U.S. Nursing Research, 1997–2015

et al. 2017

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“…13 Prehospital spine immobilization is not cost-effective for penetrating torso or extremity injuries and is unlikely to be advantageous for penetrating head injuries. 5 Cervical spine immobilization has the potential to mask potentially life-threatening conditions and impede airway or hemorrhage management. Specifically, cervical spine immobilization has been associated with an increased number of intubation attempts.…”

Section: Discussionmentioning

confidence: 99%

“…Studies on spinal motion restriction (SMR) in penetrating trauma have indicated a lack of cost-effectiveness as well as an increased risk of mortality. [4][5][6] The use of SMR may impede airway management and hemorrhage control. 4,7 Moreover, cadaveric and imaging studies suggest that concurrent cervical spine fractures are rare in GSWs to the head and indirect cervical spine injuries do not occur.…”

Section: Introductionmentioning

confidence: 99%

Cervical Spine Injury is Rare in Self-Inflicted Craniofacial Gunshot Wounds: An Institutional Review and Comparison to the US National Trauma Data Bank (NTDB)

McNickle

Chestovich

Fraser

2020

Prehosp. Disaster med.

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Background: Cadaveric and older radiographic studies suggest that concurrent cervical spine fractures are rare in gunshot wounds (GSWs) to the head. Despite this knowledge, patients with craniofacial GSWs often arrive with spinal motion restriction (SMR) in place. This study quantifies the incidence of cervical spine injuries in GSWs to the head, identified using computerized tomography (CT). Fracture frequency is hypothesized to be lower in self-inflicted (SI) injuries. Methods: Isolated craniofacial GSWs were queried from this Level I trauma center registry from 2013-2017 and the US National Trauma Data Bank (NTDB) from 2012–2016 (head or face abbreviated injury scale [AIS] >2). Datasets included age, gender, SI versus not, cervical spine injury, spinal surgery, and mortality. For this hospital’s data, prehospital factors, SMR, and CTs performed were assessed. Statistical evaluation was done with Stata software, with P <.05 significant. Results: Two-hundred forty-one patients from this hospital (mean age 39; 85% male; 66% SI) and 5,849 from the NTDB (mean age 38; 84% male; 53% SI) were included. For both cohorts, SI patients were older (P < .01) and had increased mortality (P < .01). Overall, cervical spine fractures occurred in 3.7%, with 5.4% requiring spinal surgery (0.2% of all patients). The frequency of fracture was five-fold greater in non-SI (P < .05). Locally, SMR was present in 121 (50.2%) prior to arrival with six collars (2.5%) placed in the trauma bay. Frequency of SMR was similar regardless of SI status (49.0% versus 51.0%; P = not significant) but less frequent in hypotensive patients and those receiving cardiopulmonary resuscitation (CPR). The presence of SMR was associated with an increased use of CT of the cervical spine (80.0% versus 33.0%; P < .01). Conclusion: Cervical spine fractures were identified in less than four percent of isolated GSWs to the head and face, more frequently in non-SI cases. Prehospital SMR should be avoided in cases consistent with SI injury, and for all others, SMR should be discontinued once CT imaging is completed with negative results.

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“…In prolonged rescue missions, bag-valve mask ventilation should only serve as a bridge to a protected airway. Immobilisation of the c-spine is not necessarily recommended for all blunt trauma patients (Table 2) [24][25][26] and should not be performed in neurologically intact patients with penetrating trauma [23,[27][28][29][30][31][32][33]. A clinical decision rule, such as NEXUS or the Canadian C-spine Rule, should be used to avoid secondary spinal injury [33][34][35][36].…”

Section: Grade 2cmentioning

confidence: 99%

Multiple trauma management in mountain environments - a scoping review

Sumann¹,

Moens

Brink

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background Multiple trauma in mountain environments may be associated with increased morbidity and mortality compared to urban environments. Objective To provide evidence based guidance to assist rescuers in multiple trauma management in mountain environments. Eligibility criteria All articles published on or before September 30th 2019, in all languages, were included. Articles were searched with predefined search terms. Sources of evidence PubMed, Cochrane Database of Systematic Reviews and hand searching of relevant studies from the reference list of included articles. Charting methods Evidence was searched according to clinically relevant topics and PICO questions. Results Two-hundred forty-seven articles met the inclusion criteria. Recommendations were developed and graded according to the evidence-grading system of the American College of Chest Physicians. The manuscript was initially written and discussed by the coauthors. Then it was presented to ICAR MedCom in draft and again in final form for discussion and internal peer review. Finally, in a face-to-face discussion within ICAR MedCom consensus was reached on October 11th 2019, at the ICAR fall meeting in Zakopane, Poland. Conclusions Multiple trauma management in mountain environments can be demanding. Safety of the rescuers and the victim has priority. A crABCDE approach, with haemorrhage control first, is central, followed by basic first aid, splinting, immobilisation, analgesia, and insulation. Time for on-site medical treatment must be balanced against the need for rapid transfer to a trauma centre and should be as short as possible. Reduced on-scene times may be achieved with helicopter rescue. Advanced diagnostics (e.g. ultrasound) may be used and treatment continued during transport.

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Cost-utility analysis of prehospital spine immobilization recommendations for penetrating trauma

Cited by 14 publications

References 33 publications

Quantity and Quality of Economic Evaluations in U.S. Nursing Research, 1997–2015

Quantity and Quality of Economic Evaluations in U.S. Nursing Research, 1997–2015

Cervical Spine Injury is Rare in Self-Inflicted Craniofacial Gunshot Wounds: An Institutional Review and Comparison to the US National Trauma Data Bank (NTDB)

Multiple trauma management in mountain environments - a scoping review

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