- 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.
- 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.
- 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.
- Retrospective studies.
- Little information on immobilisation type, duration.
- 1 study (n=45,284) provided most mortality events.
- This summary arose from a collaboration between Academic Emergency Medicine and the evidence-based medicine website TheNNT.