OUT-OF-HOSPITAL SPINAL IMMOBILIZATION - ITS EFFECT ON NEUROLOGIC INJURY

Objective: To examine the effect of emergency immobilization on neurol ogic outcome of patients who have blunt traumatic spinal injuries, Met hods: A 5-year retrospective chart review was carried out at 2 univers ity hospitals. All patients with acute blunt traumatic spinal or spina l cord injuries transported directly from the injury site to the hospi tal were entered, None of the 120 patients seen at the University of M alaya had spinal immobilization during transport, whereas all 334 pati ents seen at the University of New Mexico did. The 2 hospitals were co mparable in physician training and clinical resources, Neurologic inju ries were assigned to 2 categories, disabling or not disabling, by 2 p hysicians acting independently and blinded to the hospital of origin. Data were analyzed using multivariate logistic regression, with hospit al location, patient age, gender, anatomic level of injury, and injury mechanism serving as explanatory variables. Results: There was less n eurologic 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 im mobilization 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), Conclusion: Out-of-hospital immobilization ha s little or no effect on neurologic outcome in patients with blunt spi nal injuries.