Chang DC, Bonar J, Phillips J, Cornwell EE; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented By: David C. Chang, M.P.H., Doctoral Candidate, Department of Health Policy and Management, Johns Hopkins School of Public Health, 624 North Broadway, Room 501, Baltimore, MD 21205. Tel: 410-502-8455; Fax: 410-614-2797; email: dachang@jhsph.edu
Research Objective: Previous studies have suggested that patients transported by the Emergency Medical Services (EMS) following major trauma had a longer injury-to-treatment time interval and a higher mortality rate than their non-EMS transported counterparts. The EMS protocol requires many procedures to be performed on trauma patients on scene, but these procedures contribute to scene time and ultimately to total pre-hospital time, which may have negative impact on patient outcome. The purpose of this multi-disciplinary study is to examine the theoretical benefit of a potentially time-consuming procedure, namely, thoracolumbar immobilization, for patients with torso gunshot wounds (GSW). The time required for thoracolumbar immobilization may be justified only if there is a reasonable concern for the presence of an unstable spinal column injury that, if not immobilized, could lead to a deterioration in neurological status.Study Design: A retrospective analysis of prospectively gathered multi-institutional data from the Maryland Institute for Emergency Medical Service Systems (MIEMSS) State Trauma Registry was performed. The analysis included all Levels I, II, and III trauma centers in the state of Maryland from July 1, 1995 through June 30, 1998. A patient was considered to have theoretically benefited from immobilization if, after arrival in hospital, he or she was confirmed to have an unstable spinal column as evidenced by the need for an operative spinal column stabilization procedure.Population Studied: Trauma patients in the state of Maryland.Principal Findings: There were 4,247 GSW patients, with 1,000 sustaining the penetrating injury in the torso. Among the torso GSW patients, 141 patients (14.1%) had vertebral column and/or spinal cord injuries; the presence of vertebral column injury was actually associated with lower mortality (7.1% versus 14.8%, p<0.02). Two patients (0.2%) required operative spinal column stabilization, and 6 others required other spinal operations for decompression and/or foreign body removal.Conclusions: The Maryland State Trauma Registry recorded only 2 out of 1,000 (0.2%) torso GSW patients with an unstable spinal column over a 3-year period, and higher mortality rate among those GSW patients without vertebral column injury versus those with such injuries. The role of formal thoracolumbar immobilization for GSW patients should be re-examined.Implications for Policy, Delivery or Practice: The formal immobilization of the thoracolumbar spine is a time-consuming endeavor that is commonly performed to prevent further injuries in patients with unstable vertebral columns. However, the rarity of an unstable fracture secondary to GSW may well render this policy as one with limited benefit but potential risk. The benefit of avoiding disability from spinal cord injury may not warrant the risk of mortality from the delay in time to definitive treatment. Other procedures in our EMS protocol should likewise be reviewed, balancing possible benefits with possible negative implications from the delay to treatment. A "scoop and run" policy may be appropriate for certain major trauma patients. Primary Funding Source: Johns Hopkins School of Public Health
Publication Types:
Keywords:
- Emergency Medical Services
- Evaluation Studies
- Humans
- Immobilization
- Lumbar Vertebrae
- Maryland
- Registries
- Spinal Cord Injuries
- Spinal Injuries
- Trauma Centers
- Wounds, Gunshot
- Wounds, Penetrating
- injuries
- methods
- hsrmtgs
Other ID:
UI: 102272223
From Meeting Abstracts