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No Spine Immobilization in Penetrating Trauma per EAST

February 20, 2018

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EAST concluded spine immobilization in penetrating trauma is unnecessary and associated with an increase in mortality.

Why does this matter?
Spine immobilization is undertaken in patients with penetrating neck trauma, despite good evidence for any benefit.  It obscures the wound and may delay intervention or complicate intubation.  Usually penetrating neck injuries are completed on impact and not improved with immobilization or surgery.  And the authors note, “Even those injuries deemed unstable and requiring operative fixation are not helped by immobilization with cervical collar or spine board since these methods are not particularly effective.”

Spine dilemma
EAST performed a meta-analysis of 5 studies on spine immobilization in penetrating trauma and found no benefit. In fact, it was associated with harm, with more than twice the risk for mortality in those immobilized.  Only 2 studies looked at mortality; one had >45,000 patients, and the other about 130.  So the meta-analysis was heavily influenced by one study. The rate of potentially reversible neurological deficit ranged from 0.034% to 5.5%.  Weighing the strong association with harm and very small chance of preventing worsening of neurological injury by immobilization, EAST concluded, “that spine immobilization not be used routinely for adult patients with penetrating trauma.”

Prehospital Spine Immobilization/Spinal Motion Restriction in Penetrating Trauma: a Practice Management Guideline from the Eastern Association for the Surgery of Trauma (EAST). J Trauma Acute Care Surg. 2017 Dec 28. doi: 10.1097/TA.0000000000001764. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.

What are your thoughts?