Ee. Cornwell et al., Thoracolumbar immobilization for trauma patients with torso gunshot wounds- Is it necessary?, ARCH SURG, 136(3), 2001, pp. 324-327
Background: Previous studies have suggested that patients transported by em
ergency medical services (EMS) following major trauma had a longer injury-t
o-treatment interval and a higher mortality rate than their non-EMS-transpo
rted counterparts.
Hypothesis: There is little actual benefit of thoracolumbar immobilization
for patients with torso gunshot wounds (GSW).
Design: Retrospective analysis of prospectively gathered data from the Mary
land Institute for Emergency Medical Service Systems State Trauma Registry
from July 1, 1995,through June 30, 1998.
Settings: All designated trauma centers in Maryland.
Patients: All patients with torso GSW.
Main Outcome Measures: (1) A patient was considered to have benefited from
immobilization if he or she had less than complete neurologic deficits in t
he presence of an unstable vertebral column, as shown by the need for opera
tive stabilization of the vertebral column; (2) mortality.
Results: There were 1000 patients with torso GSW. Among them, 141 patients
(14.1%) had vertebral column and/or spinal cord injuries. Two patients (0.2
%) (95% confidence interval, -0.077% to 0.48%) required operative vertebral
column stabilization, while 6 others required other spinal operations for
decompression and/or foreign body removal. The presence of vertebral column
injury was actually associated with. lower mortality (7.1% vs 14.8%, P<.02
).
Conclusions: This study suggests that thoracolumbar immobilization is almos
t never beneficial in patients with torso GSW, and that a higher mortality
rate existed among those GSW patients without vertebral column injury vs th
ose with such injuries. The role of formal thoracolumbar immobilization for
patients with torso GSW should be reexamined.