A multicenter cohort study on the association between prehospital immobilization and functional outcome of patients following spinal injury in Asia

Abstract

Prehospital spinal immobilization is a widely used procedure in the emergency medical service (EMS) system worldwide, while the incidence of patients with spinal injury (SI) is relatively low, and unnecessary prehospital spinal immobilization is associated with patient complications. This study aimed to determine the association between prehospital spine immobilization and favorable functional outcomes at hospital discharge among trauma patients with SI. We conducted a retrospective cohort study using the Pan-Asia Trauma Outcomes Study (PATOS) registry data from January 1, 2016, to November 30, 2018. A total of 759 patients with SI were enrolled from 43,752 trauma patients in the PATOS registry during the study period. The subjects had a median age of 58 years (Q1-Q3, 41-72), and 438 (57.7%) patients had prehospital spine immobilization. Overall, prehospital spinal immobilization was not associated with favorable functional outcomes at discharge in multivariable logistic regression (aOR 1.06; 95% CI 0.62-1.81, p = 0.826). However, in the subgroup of cervical SI, prehospital spinal immobilization was associated with favorable functional outcomes at discharge (aOR 3.14; 95% CI 1.04-9.50; p = 0.043). Therefore, we suggest that paramedics should be more careful when determining the presence of a cervical SI and should apply full spine immobilization if possible.

Figure 1

Flow diagram of patients included in our study. GOS Glasgow outcome scale, mRS modified Rankin Scale, RTS revised trauma score, StoH time Scene-to-hospital time. *Patients with spinal injury were defined as meeting the diagnosis of ICD-9 or 10 described in the methods.

Figure 2

Subgroup analysis for favorable neurologic outcome, ISS < 9, ISS ≥ 9, age ≥ 65, age < 65, adjusted multivariable logistic regression. aOR adjusted odds ratio, SI spinal injury. *All subgroups except RTS < 7 were adjusted by country, age, sex, scene-to-hospital time, mechanism, prehospital fluid management, cervical spinal injury, thoracic spinal injury, lumbar spinal injury, torso injury, revised trauma score, ISS, received spine operation, and received other operations. **Due to the small subgroup size, multivariable logistic regression was not applicable.