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Spine Immobilization in Penetrating Trauma: More Harm Than Good?

Haut, Elliott R. MD; Kalish, Brian T. BA, EMT-B; Efron, David T. MD; Haider, Adil H. MD, MPH; Stevens, Kent A. MD, MPH; Kieninger, Alicia N. MD; Cornwell, Edward E. III MD; Chang, David C. MBA, MPH, PhD

The Journal of Trauma: Injury, Infection, and Critical Care: January 2010 - Volume 68 - Issue 1 - p 115-121
doi: 10.1097/TA.0b013e3181c9ee58
Original Article

Background: Previous studies have suggested that prehospital spine immobilization provides minimal benefit to penetrating trauma patients but takes valuable time, potentially delaying definitive trauma care. We hypothesized that penetrating trauma patients who are spine immobilized before transport have higher mortality than nonimmobilized patients.

Methods: We performed a retrospective analysis of penetrating trauma patients in the National Trauma Data Bank (version 6.2). Multiple logistic regression was used with mortality as the primary outcome measure. We compared patients with versus without prehospital spine immobilization, using patient demographics, mechanism (stab vs. gunshot), physiologic and anatomic injury severity, and other prehospital procedures as covariates. Subset analysis was performed based on Injury Severity Score category, mechanism, and blood pressure. We calculated a number needed to treat and number needed to harm for spine immobilization.

Results: In total, 45,284 penetrating trauma patients were studied; 4.3% of whom underwent spine immobilization. Overall mortality was 8.1%. Unadjusted mortality was twice as high in spine-immobilized patients (14.7% vs. 7.2%, p < 0.001). The odds ratio of death for spine-immobilized patients was 2.06 (95% CI: 1.35-3.13) compared with nonimmobilized patients. Subset analysis showed consistent trends in all populations. Only 30 (0.01%) patients had incomplete spinal cord injury and underwent operative spine fixation. The number needed to treat with spine immobilization to potentially benefit one patient was 1,032. The number needed to harm with spine immobilization to potentially contribute to one death was 66.

Conclusions: Prehospital spine immobilization is associated with higher mortality in penetrating trauma and should not be routinely used in every patient with penetrating trauma.

From the Division of Acute Care Surgery (E.R.H., B.T.K., D.T.E., A.H.H., K.A.S., D.C.C.), Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Acute and Critical Care Section (A.N.K.), Division of General Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; and Department of Surgery (E.E.C.), Howard University College of Medicine, Washington, DC.

Submitted for publication November 13, 2008.

Accepted for publication September 4, 2009.

Presented as a poster presentation at the 67th Annual Meeting of the American Association for the Surgery of Trauma, September 24-27, 2008, Maui, Hawaii.

Address for reprints: Elliott R. Haut, MD, FACS, Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins Hospital, 600 North Wolfe Street, 625 Osler, Baltimore, MD 21287; email:

© 2010 Lippincott Williams & Wilkins, Inc.