The Impact of Prehospital Spinal Immobilization in Patients with Penetrating Spinal Injuries: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Literature Search
2.2. Inclusion and Exclusion Criteria
2.3. Data Collection Process
2.4. Data Extraction and Synthesis
2.5. Quality Assessment and Statistical Analysis
2.6. Risk of Bias
3. Results
3.1. Study Selection
3.2. Study Characteristics
3.3. Results of Individual Studies
3.4. Meta-Analysis for Overall Mortality in PHSI vs. Non-PHSI Patients
3.5. Bias Assessment
4. Discussion
4.1. Common Themes
4.2. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Study | Location | Study Period | Study Setting | Number of Patients | Percentage Receiving PHSI | Type of Injury | ISS/GCS | Mortality PHSI/Non-PHSI |
---|---|---|---|---|---|---|---|---|
Schubl et al. [23] | New York, USA | 4 years | Level 1 trauma center | 156 | 37.2% | GSW = 20.5% SW = 79.5% | 11 (range 4–22 patients) | 10.3% vs. 2.0% |
Haut et al. [1] | USA | 3 years | NTDB | 45,284 | 4.3% | GSW = 42.3% SW = 57.7% | <9 (49.5%); 9–15 (28.5%); 16–25 (9.4%); >25 (12.6%) | 14.7% vs. 7.2% |
Turnock et al. [25] | Michigan and Louisiana, USA | 5 years and 9 years | Level 1 trauma centers | 231 | Charity Hospital 54.90% Hurley Hospital 25.58% | Charity Hospital GSW = 38.56% SW = 61.44% Hurley Hospital GSW = 48.84% SW = 51.16% | Not reported | 11.7% vs. 3.5% |
Vanderlan et al. [24] | Louisiana, USA | 9 years | Level 1 trauma center in Louisiana | 188 | 62.3% | GSW = 94% SW = 6% | GCS 3 (n = 30); 15 (n = 4), 8 (n = 1) | 14.4% vs. 4.3% |
Brown et al. [22] | New York, USA | 3.5 years and 5 years | Level 1 trauma centers and NTDB | 75,567 | Strong Memorial Hospital, 54% NTDB N/A | GSW = 100% | Not reported | Not reported |
Cornwell et al. [26] | USA | 3 years | Maryland State Trauma Registry data | 141 | N/A | GSW = 100% | ISS > 13 | Not reported |
References | Study Type | GRADE Quality | Study Conclusions |
---|---|---|---|
Schubl et al. [23] | Retrospective analysis | Moderate | Odds of mortality were higher in patients who underwent prehospital spinal immobilization than those without. |
Haut et al. [1] | Retrospective analysis | High | Risks of spinal immobilization in penetrating injury outweigh the benefits. The study supports the recommendations by the PHTLS that suggest the discontinuation of PHSI in penetrating trauma in favor of a favorable selective approach. |
Turnock et al. [25] | Retrospective analysis | High | No benefits of spinal immobilization. |
Vanderlan et al. [24] | Retrospective review | Moderate | PHSI increases the risk of mortality in penetrating trauma patients. |
Brown et al. [22] | Retrospective analysis | High | Potential benefits of PHSI remain unproven. PHSI might be beneficial for patients with spinal fractures and require surgical immobilization without SCI. PHSI may further complicate care after a gunshot injury to the torso, and a small sample from the study benefited from PHSI. |
Cornwell et al. [26] | Retrospective analysis | Moderate | Minimal advantages are gained by the immobilization of patients sustaining torso gunshot wounds. Need for re-evaluating the use of thoracolumbar immobilization. |
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Alghamdi, I.; Bazaie, N.; Alqurashi, N.; Ahmed, Z. The Impact of Prehospital Spinal Immobilization in Patients with Penetrating Spinal Injuries: A Systematic Review and Meta-Analysis. Trauma Care 2022, 2, 226-237. https://doi.org/10.3390/traumacare2020019
Alghamdi I, Bazaie N, Alqurashi N, Ahmed Z. The Impact of Prehospital Spinal Immobilization in Patients with Penetrating Spinal Injuries: A Systematic Review and Meta-Analysis. Trauma Care. 2022; 2(2):226-237. https://doi.org/10.3390/traumacare2020019
Chicago/Turabian StyleAlghamdi, Ibrahim, Naif Bazaie, Naif Alqurashi, and Zubair Ahmed. 2022. "The Impact of Prehospital Spinal Immobilization in Patients with Penetrating Spinal Injuries: A Systematic Review and Meta-Analysis" Trauma Care 2, no. 2: 226-237. https://doi.org/10.3390/traumacare2020019