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Spinal Immobilization question and evidence based medicine

Timothy J Coats trauma-list@trauma.org
Wed, 6 Feb 2002 12:26:24 BST 

Comparisons and large database collection is always tempting, but the 
problem is that there are so many other differences between various 
countries that you could not be sure that any result was due to the 
difference that you were studying (immobilisation) rather than some 
other factor (unmeasured). An RCT would be the only way of being 
relatively sure of the answer. The ethical issues are the same as any 
other change in established treatment (like not giving fluids to 
penetrating thoracic trauma victims!). Categorising a question as "too 
difficult" is not going to get us anywhere.

Tim.

> 
> I think that the problem of a RCT for immobilization could be
> side-stepped if  information from various countries with different
> standards of care could be gathered in one location.  That would give
> one the ability to compare outcomes in patients with similar mechanism
> of injury and/or chief complaint who received different treatment
> modalities.
> 




Timothy J Coats MD FRCS FFAEM
Senior Lecturer in Accident and Emergency / Pre-Hospital Care
Royal London Hospital, UK.