Out‐of‐hospital Spinal Immobilization: Its Effect on Neurologic Injury

Abstract

Objective:To examine the effect of emergency immobilization on neurologic outcome of patients who have blunt traumatic spinal injuries. Methods: A 5-year retrospective chart review was carried out at 2 university hospitals. All patients with acute blunt traumatic spinal or spinal cord injuries transported directly from the injury site to the hospital were entered. None of the 120 patients seen at the University of Malaya had spinal immobilization during transport, whereas all 334 patients seen at the University of New Mexico did. The 2 hospitals were comparable in physician training and clinical resources. Neurologic injuries were assigned to 2 categories, disabling or not disabling, by 2 physicians acting independently and blinded to the hospital of origin. Data were analyzed using multivariate logistic regression, with hospital location, patient age, gender, anatomic level of injury, and injury mechanism serving as explanatory variables. Results: There was less neurologic disability in the unimmobilized Malaysian patients (OR 2.03; 95% CI 1.03-3.99; p = 0.04). This corresponds to a ~2 % chance that immobilization has any beneficial effect. Results were similar when the analysis was limited to patients with cervical injuries (OR 1.52; 95% CI 0.64-3.62; p = 0.34). Conclusion: Out-of-hospital immobilization has little or no effect on neurologic outcome in patients with blunt spinal injuries.

Part 17: First Aid

“…This could result in permanent neurological damage including quadriplegia. 106,107 Only one controlled but underpowered study with some methodological problems 108 has examined this question. In the study, the group of injured victims with spinal immobilization by emergency medical technicians using equipment failed to show any neurological benefit compared with a group of injured victims without spinal immobilization.…”

The Impact of Trauma Care Systems in Low- and Middle-Income Countries

“…Reynolds et al Process (3,5,6,9,12,13,14,15,20,21,46,50,53,54,57,64,67,68,69,71,86,93,103) 23 (32) Clinical or population health outcome (3,4,12,14,15,16,17,18,19,22,23,24,28,29,35,36,41,42,43,45,48,49,53,54,57,59,60,61,64,…”

The definite risks and questionable benefits of liberal pre-hospital spinal immobilisation

“…[19]  Confounding clinical examination and vital sign recordings. [20] Hauswald, [21] and the authors of three systematic reviews, [18,22,23] conclude that phSI may be contributing to patient morbidity and mortality.…”

“…This may indicate that the practice has an overall negative effect on patient outcomes. [21] He proposes that local hypoxia and oedema are greater contributors to secondary neurological injury than the risk of mechanical severance. If true, his hypothesis would strongly oppose the current school of thought on phSI.…”