How dangerous is spinal immobilization? We discuss that on First Few Moments. On this Spinal Immobilization podcast, Kyle David Bates, Russell Stine, Bob Lutz, Dr. Laurie Romig, Kelly Grayson and I discuss the lack of evidence of any benefit from spinal immobilization and the evidence of harm.
What is it going to take to get the medical directors, PHTLS (PreHospital Life Support), BTLS (Basic Trauma Life Support), and ATLS (Advanced Trauma Life Support) to eliminate this dogma?
What is it going to take to get someone to do a large enough study of this dogma to find out just how good/bad spinal immobilization really is?
The Cochrane Reviews looked at spinal immobilization and were not impressed –
The review authors could not find any randomised controlled trials of spinal immobilisation strategies in trauma patients. It is feasible to have trials comparing the different spinal immobilisation strategies. From studies of healthy volunteers it has been suggested that patients who are conscious, might reposition themselves to relieve the discomfort caused by immobilisation, which could theoretically worsen any existing spinal injuries.
We did not find any randomised controlled trials that met the inclusion criteria. The effect of spinal immobilisation on mortality, neurological injury, spinal stability and adverse effects in trauma patients remains uncertain. Because airway obstruction is a major cause of preventable death in trauma patients, and spinal immobilisation, particularly of the cervical spine, can contribute to airway compromise, the possibility that immobilisation may increase mortality and morbidity cannot be excluded.
Spinal immobilisation for trauma patients.
Kwan I, Bunn F, Roberts I.
Cochrane Database Syst Rev. 2001;(2):CD002803. Review.
PMID: 11406043 [PubMed – indexed for MEDLINE]
There is only one large scale study comparing spinal immobilization with no spinal immobilization –
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).
Out-of-hospital spinal immobilization: its effect on neurologic injury.
Hauswald M, Ong G, Tandberg D, Omar Z.
Acad Emerg Med. 1998 Mar;5(3):214-9.
PMID: 9523928 [PubMed – indexed for MEDLINE]
Kyle starts out with a great comment for all of those who say that we should not discuss, or criticize, our current protocols, for whatever reason they give.
**This podcast is not meant to change YOUR current practice, only your medical director can do that! …but nothing says you can’t try to convince them – KDB**
Not a formula for success.
What do you think?