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Thoracolumbar Immobilization for Trauma Patients With Torso Gunshot Wounds
Is It Necessary?
Edward E. Cornwell III, MD;
David C. Chang, MPH;
James P. Bonar, MD;
Kurtis A. Campbell, MD;
Judy Phillips, RN;
Pamela Lipsett, MD;
Thomas Scalea, MD;
Robert Bass, MD
Arch Surg. 2001;136:324-327.
Background Previous studies have suggested that patients transported by emergency medical services (EMS) following major trauma had a longer injury-to-treatment interval and a higher mortality rate than their non-EMS–transported 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 Maryland 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 the presence of an unstable vertebral column, as shown by the need for operative 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 almost never beneficial in patients with torso GSW, and that a higher mortality rate existed among those GSW patients without vertebral column injury vs those with such injuries. The role of formal thoracolumbar immobilization for patients with torso GSW should be reexamined.
From the Department of Surgery, Adult Trauma Service, The Johns Hopkins Medical Institutions (Drs Cornwell, Bonar, Campbell, and Lipsett and Ms Phillips); Department of Health Policy and Management, The Johns Hopkins School of Public Health (Mr Chang); University of Maryland School of Medicine (Dr Scalea); and Maryland Institute for Emergency Medical Service Systems (Dr Bass), Baltimore, Md.
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