Background: Despite the common application of pre-clinical immobilisation in trauma patients for many years, the existing evidence for this intervention is still weak. The need for pre-clinical immobilisation and applying the right immobilisation procedures on the right trauma patients is still controversial in the scientific literature. Objectives: This systematic review aims to compare different outcomes to answer whether the pre-clinical immobilisation of trauma patients is more effective than no pre-clinical Immobilisation and analyse it critically. Methods: A systematic literature search was conducted according to the PRISMA criteria in the Pubmed and EMBASE databases with meta-analyses. We searched for randomised controlled trials (RCTs) and no randomised studies of intervention (NRSIs, both prospective and retrospective studies) comparing two different groups of trauma patients (pre-clinical immobilisation vs no pre-clinical immobilisation). We set no time or language limitations. Two reviewers screened the title/abstracts and the full-texts independently. We resolved any conflicts with discussion. Results: We identified 2,726 studies from Pubmed and EMBASE. After double stage screening, a total of 13 studies were included in the systematic review. Both spinal injuries (OR= 3.69, 95% CI from 1.82 to 7.49) and neurological deficits (OR= 2.67, 95% CI from 1.15 to 6.18) occurred in the pre-clinical immobilised patients significantly more often than non immobilised. We found higher mortality (OR= 1.97, 95% CI from 1.12 to 3.46) and six times higher side effects (OR= 6.01, 95% CI from 2.880 to 12.91) in the group of pre-clinical immobilisation compared to the control. Conclusions: Pre-clinical immobilisation seems unable to reduce the neurological deficits, mortality, or spine injuries in trauma patients than no-immobilisation. The side-effects of the intervention are higher than the control. The quality of evidence is low. Regarding this topic, there is a critical need for primary studies in general and randomised controlled trials in specific.
Background. Suicide is a major problem worldwide, and jumping from a height is a common suicide method in Europe and Germany. This method primarily results in severe spinal fractures. As a maximum-care hospital in Berlin, we observed an increase in severe spine fractures due to suicidal jumping.Objective. To describe the characteristics of these fractures in suicidal jumpers compared to non-suicidal individuals and analyse their association with the COVID-pandemic. Method. We extracted the chart data of patients who suffered severe spine fractures (from thoracic vertebra 1 to lumbar vertebra 5) due to trauma and who were treated surgically in our centre between 01 January 2015 and 31 May 2021. Results. Seventy-one patients were included in the study. Suicidal jumpers were about 11 years younger (p = 0.008) and more likely to be female (relative risk= 1.3, p = 0.47). The two groups differed in their initial haemoglobin values (mean difference= two g/dl, p <0.001). The lumbar region was twice as affected in suicidal jumpers (p = 0.02). Before the COVID-lockdown within 63 months, there were 19 suicide cases and 38 non-suicidal cases. After COVID-lockdown within 14 months, 11 suicidal cases vs only three non-suicides resulted in a ratio of 2.57 (p-value<0.001). There were no significant differences in radiological and clinical outcomes. Conclusions. Spine fractures in suicide jumpers differ from those in non-suicide jumpers in terms of age, initial haemoglobin level, and spine region. These fractures have increased significantly in Berlin since the COVID lockdown. Surgical treatment of these fractures provided the same results in both groups.
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