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Tue, 05 Feb 2002 14:02:30 +0000

Dear friends;

Great discussion regarding spinal immobilization. In terms of spinal 
immobilization and evidence based medicine in truly think it's a difficult 
are to study as I don't know of any service that will submit their patients 
to a randomized controlled trail assessing the benefits of spinal 
immobilization versus none. Thus the RCT gold standard in evidence based 
medicine has limited applicability in this setting and makes it very 
difficult to assess therapeutic classes and benefits. We could probably look 
into retrospective studies and obtain assumptions based on these, please 
find a 1989 study published in J trauma by a group of military researchers. 
I think it will be of your interest.

Amado A. Baez MD MSc
Chicago, IL
---------------------------------------------

Arishita GI, Vayer JS, Bellamy RF.Cervical spine immobilization of 
penetrating neck wounds in a hostile environment.J Trauma 1989 
Mar;29(3):332-7

Department of Military Medicine, Uniformed Services University of the Health 
Sciences, Bethesda, MD 20814-4799.

Current guidelines concerning trauma suggest that cervical spine 
immobilization be performed on all patients with penetrating wounds of the 
neck. This study was undertaken to examine the risks and benefits likely to 
be found when such care is provided in a hazardous environment, such as the 
battlefield, or the scene of a terrorist attack or domestic criminal action. 
Data for casualties from the Vietnam conflict were reviewed to determine the 
potential benefit of cervical spine immobilization on the battlefield. In 
this population, penetrating cervical cord injury was always fatal and 
usually immediately so. Only 1.4% of all casualties who were candidates for 
immobilization might have benefitted from the care. However, the risk of 
performing immobilization in a hazardous environment is substantial since 
about 10% of casualties are incurred while helping other casualties. 
Mandatory immobilization of all casualties with penetrating neck wounds 
sustained in an environment hazardous to first aid providers has an 
unfavorable risk/benefit ratio.

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Spinal Immobilization question and evidence based medicine