Prehospital Backbone Immobilization/Spinal Movement Restriction in Penetrating Trauma: a Follow Administration Guideline from the Jap Affiliation for the Surgical procedure of Trauma (EAST).
J Trauma Acute Care Surg. 2017 Dec 28;:
Authors: Velopulos CG, Shihab HM, Lottenberg L, Feinman M, Raja A, Salomone J, Haut ER
BACKGROUND: Backbone immobilization in trauma has remained an integral a part of most emergency medical providers (EMS) protocols regardless of an absence of proof for efficacy and concern for related issues, particularly in penetrating trauma sufferers. We reviewed the printed proof on the subject of prehospital backbone immobilization or spinal movement restriction in grownup sufferers with penetrating trauma to construction a Follow Administration Guideline.
METHODS: We performed a Cochrane fashion systematic overview and meta-analysis, and utilized GRADE methodology to assemble suggestions. Qualitative and quantitative analyses have been used to guage the literature on the crucial outcomes of mortality, neurologic deficit, and probably reversible neurologic deficit.
RESULTS: A complete of 24 research met inclusion standards, with qualitative overview performed for all research. We used 5 research for the quantitative overview (meta-analysis). No examine confirmed profit to backbone immobilization with regard to mortality and neurologic harm, even for sufferers with direct neck harm. Elevated mortality was related to backbone immobilization, with RR 2.four (CI 1.07, 5.41). The speed of neurologic harm or probably reversible harm was very low, starting from zero.002 to zero.076 and zero.00034 to zero.055, with no statistically important distinction for neurologic deficit or probably reversible deficit, RR four.16 (CI zero.56, 30.89), and RR 1.19 (CI zero.83, 1.70), though the purpose estimates favored no immobilization.
CONCLUSIONS: Backbone immobilization in penetrating trauma is related to elevated mortality and has not been proven to have a useful impact on mitigating neurologic deficits, even probably reversible neurologic deficits. We suggest that backbone immobilization not be used routinely for grownup sufferers with penetrating trauma.
LEVEL OF EVIDENCE: Degree II STUDY TYPE: Systematic Overview with Meta-analysis.
PMID: 29283970 [PubMed – as supplied by publisher]