Spine immobilization in penetrating trauma: more harm than good?

@article{Haut2010SpineII,
  title={Spine immobilization in penetrating trauma: more harm than good?},
  author={Elliott R. Haut and Brian T. Kalish and David Thomas Efron and Adil Haider and Kent A. Stevens and Alicia N. Kieninger and Edward E. Iii Cornwell and David C. Chang},
  journal={The Journal of trauma},
  year={2010},
  volume={68 1},
  pages={
          115-20; discussion 120-1
        }
}
BACKGROUND Previous studies have suggested that prehospital spine immobilization provides minimal benefit to penetrating trauma patients but takes valuable time, potentially delaying definitive trauma care. [] Key MethodMETHODS We performed a retrospective analysis of penetrating trauma patients in the National Trauma Data Bank (version 6.2). Multiple logistic regression was used with mortality as the primary outcome measure.
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Cost-utility analysis of prehospital spine immobilization recommendations for penetrating trauma
TLDR
PHSI was not cost-effective for patients with torso or extremity penetrating trauma and despite increased incidence of unstable spine injures produced by penetrating head or neck injuries, the cost-benefit of PHSI in these patients is equivocal, and further studies may be needed before omitting PHSi in patients with penetrating head and neck injuries.
Prehospital spine immobilization for penetrating trauma--review and recommendations from the Prehospital Trauma Life Support Executive Committee.
TLDR
No study has demonstrated that penetrating trauma can produce an unstable spine injury, and progression of spinal cord injury has not been demonstrated to occur following penetrating trauma, which has a different mechanism of injury from blunt trauma.
Prehospital interventions for penetrating trauma victims: a prospective comparison between Advanced Life Support and Basic Life Support.
Patients Immobilized with a Long Spine Board Rarely Have Unstable Thoracolumbar Injuries
TLDR
The goal of this research was to determine the prevalence of unstable thoracolumbar spine injuries among patients receiving prehospital spine immobilization: a 4-year retrospective review of adult subjects who received prehospital spinal immobilization and were transported to a trauma center.
Association between spinal immobilization and survival at discharge for on-scene blunt traumatic cardiac arrest: A nationwide retrospective cohort study.
Utility of Spinal Immobilization in Patients with Penetrating Trauma.
TLDR
There is limited evidence regarding the ability of spinal immobilization to improve patient outcomes among those with penetrating trauma, and spinal immobilizations may increase complications.
An Eastern Association for the Surgery of Trauma multicenter trial examining prehospital procedures in penetrating trauma patients
TLDR
Prehospital procedures in penetrating trauma patients impart no survival advantage and may be harmful in urban settings, even when performed during transport, and PHP should be forgone in lieu of immediate transport to improve patient outcomes.
Prehospital spine immobilization/spinal motion restriction in penetrating trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma (EAST)
TLDR
It is recommended that spine immobilization not be used routinely for adult patients with penetrating trauma, and has not been shown to have a beneficial effect on mitigating neurologic deficits, even potentially reversible neurologic deficit.
Title Association between spinal immobilization and survival at discharge for on-scene blunt traumatic cardiac arrest: A nationwide retrospective cohort
TLDR
It is suggested that spinal immobilization should not be routinely recommended for all blunt TCA patients, even though it is associated with a lower rate of survival at discharge and ROSC by admission.
Epidemiology and predictors of traumatic spine injury in severely injured patients: implications for emergency procedures
TLDR
In addition to the clinical symptoms of pain, ‘4S’ is identified as an indication for increased attention for CSIs or indication for spinal motion restriction in patients over 65 years of age.
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References

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Is spinal immobilisation necessary for all patients sustaining isolated penetrating trauma?
Thoracolumbar immobilization for trauma patients with torso gunshot wounds: is it necessary?
TLDR
It is suggested that thoracolumbar immobilization is almost never beneficial in patients with torso GSW, and that a higher mortality rate existed among those GSW patients without vertebral column injury vs those with such injuries.
Patients with gunshot wounds to the head do not require cervical spine immobilization and evaluation.
TLDR
Indirect spinal injury does not occur in patients with gunshot wounds to the head and protocols mandating cervical spine immobilization after a gunshot wound to theHead are unnecessary and may complicate airway management.
Incidence of Cervical Spine Injury in Patients With Gunshot Wounds to the Head
TLDR
It is concluded that cervical spine immobilization may not be required during endotracheal intubation of brain-injured gunshot victims with wounds limited to the calvaria.
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TLDR
The risks and benefits likely to be found when such care is provided in a hazardous environment, such as the battlefield, or the scene of a terrorist attack or domestic criminal action, are examined.
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TLDR
In urban centers with highly specialized level I trauma centers, there is no benefit in having on-site ALS for the prehospital management of trauma patients.
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TLDR
The OPALS Major Trauma Study showed that systemwide implementation of full advanced life-support programs did not decrease mortality or morbidity for major trauma patients, and it was found that during the advancedlife-support phase, mortality was greater among patients with Glasgow Coma Scale scores less than 9.
Prehospital stabilization of the cervical spine for penetrating injuries of the neck - is it necessary?
Prospective Performance Assessment of an Out-of-Hospital Protocol for Selective Spine Immobilization Using Clinical Spine Clearance Criteria
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TLDR
Most trauma practitioners believe that emergency medical services providers should attempt intubation for a patients with a severe traumatic brain injury, should treat decompensated shock in a patient with penetrating torso trauma but maintain the patient in a relatively hypotensive state, and should apply and inflate the pneumatic antishock garment for a suspected pelvic fracture accompanied by decompensation shock.
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