EBP Project Abstract
Appraised by: Kristina McCormick, Micah Munson and Ariel Mack
Clinical Question:
In trauma patients, with suspected spinal injuries, does spinal immobilization
increase the risk of morbidity or mortality?
Articles:
Abram, S., & Bulstrode, C. (2010). Routine spinal immobilization in trauma patients:
What are the advantages and disadvantages? The Surgeon, Journal of the
Royal Colleges of Surgeons of Edinburgh and Ireland , 8 (2010), 218-222.
Haut, E. R., Kalish, B. T., Efron, D. T., Haider, A., Stevens, K. A., Kieninger, A. N., et al.
(2010). Spine immobilization in penetrating trauma; more harm than good?
The Journal of Trauma; Injury, Infection, and Critical Care , 68 (1), 115-121.
Stuke, L. E., Pons, P. T., Guy, J. S., Chapleau, W. P., Butler, F. K., & McSwain, N. E.
(2011). Prehospital spinal immobilization for penetrating trauma-review and
recommendations from the prehospital trauma life support executive
committee. The Journal of Trauma: Injury, Infection and Critical Care , 71 (3),
763-770.
Synthesis of Evidence:
The overall quality of these studies is good. Each study was consistent with their
findings that spinal immobilization causes increased morbidity mortality. Both of
the systematic reviews researched a sufficient amount of studies to report their
findings. The study by Haut et. al. had a sufficient sample size of 45,284. The studies
have reasonable control over the methodology. Each of these articles show evidence
that spinal immobilization is no longer the best practice for our patients. Each study
showed similar reasons that spinal immobilization can harm patients including
increased intracranial pressure, impeding endotracheal intubation, impairing
respiratory function, inability to recognize other life threatening problems and
many others. They all explained that spinal immobilization is a time consuming
intervention when the best intervention is getting our patients to the hospital
quickly. All the studies had similar recommendations suggesting that spinal
immobilization can increase morbidity and mortality.
Bottom Line:
The evidence suggests the use of spinal immobilization increases morbidity and
mortality rates in trauma patients. Therefore, we suggest a Selective Spinal
Immobilization Protocol.
Implications for Nursing Practice:
For nursing these studies are significant in any trauma situation. The nurse can be
an advocate for establishing a more selective protocol for spinal immobilization by
educating other people about the risks of spinal immobilization and helping to
decrease the time a patient is immobilized. Prompt care and accurate assessment
skills are necessary in improving mortality rates in trauma patients. This includes
the prompt removal of spinal immobilization and knowing when it is appropriate to
immobilization the patient. There are appropriate times to apply spinal
immobilization and it is important to know when. We recommend that spinal
immobilization should not be applied based on mechanism of injury and a Selective
Spinal Immobilization Protocol should be developed. The protocol should state
which signs or symptoms warrant the intervention of spinal immobilization. This
protocol should include altered mental status, evidence of intoxication, neurologic
defect, suspected extremity fracture and spine pain or tenderness.