Spinal Immobilisation Vs No-immobilisation in Trauma Patients: a Systematic Review and Meta-analysis

Abstract

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.

Cervical spine immobilisation following blunt trauma in pre-hospital and emergency care: A systematic review

“…Each note the lack of robust evidence to support cervical spine immobilisation and significant potential for harm. Unlike these systematic reviews [13][14][15]34,35], and others [36,37], our review included only comparative studies, and specifically excluded studies which were conducted in healthy human volunteers (non-trauma), cadaver or manikin models, and patients with penetrating neck or spinal trauma. The relevance and generalisability of the inclusion of these studies to injured humans who have a suspected blunt spinal injury would have been questionable due to the absence of pain, difficulty in replication of biomechanical behaviour of an injured spine in the field, and the lack of evidence that parameters of force or movement will translate to clinical outcomes.…”