Spinal immobilisation not recommended for penetrating trauma

  • Long B & al.
  • Acad Emerg Med
  • 8 Sep 2019

  • International Clinical Digest
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Takeaway

  • Authors summarised a guideline from the Eastern Association for the Surgery of Trauma (EAST) on spinal immobilisation for patients with penetrating trauma.
  • The conclusion: “Spinal immobilisation is not recommended for routine use in penetrating trauma.”

Why this matters

  • Spinal immobilisation carries important risks, including increased intracranial pressure, localised pressure injury, overlooked wounds, and delay of procedures like intubation.

Key results

  • Neurologic injury incidence: 
    • 2-76 per 1000 patients.
    • 136-204 per 1000 patients with head and neck injuries.
  • No study found benefit for immobilisation with regard to mortality or neurologic injury.
  • Mortality risk was higher with immobilisation vs without: 
    • Relative risk: 2.4 (95% CI, 1.07-5.4).
    • Absolute risk difference: 10.1% (95% CI, 0.5%-31.7%).
    • Number needed to harm: 10.
  • There was no significant difference in neurologic deficits or potentially reversible deficits.

Study design

  • Concise summary of systematic review and meta-analysis comprising:
    • 24 studies of various designs (n=155,089) for qualitative analysis.
    • 5 retrospective studies (n=46,092) for quantitative analysis.
  • Outcomes: mortality, neurologic deficits, neurologic deficits potentially reversible or improvable via immobilisation.
  • Funding: None disclosed.

Limitations

  • Retrospective studies.
  • Little information on immobilisation type, duration.
  • 1 study (n=45,284) provided most mortality events.

Additional information

  • This summary arose from a collaboration between Academic Emergency Medicine and the evidence-based medicine website TheNNT.