title: Out-of-hospital spinal immobilization: its effect on neurologic injury.
abstract: OBJECTIVE
  To examine the effect of emergency immobilization on neurologic outcome of patients who have blunt traumatic spinal injuries.
  
  
  METHODS
  A 5-year retrospective chart review was carried out at 2 university hospitals. All patients with acute blunt traumatic spinal or spinal cord injuries transported directly from the injury site to the hospital were entered. None of the 120 patients seen at the University of Malaya had spinal immobilization during transport, whereas all 334 patients seen at the University of New Mexico did. The 2 hospitals were comparable in physician training and clinical resources. Neurologic injuries were assigned to 2 categories, disabling or not disabling, by 2 physicians acting independently and blinded to the hospital of origin. Data were analyzed using multivariate logistic regression, with hospital location, patient age, gender, anatomic level of injury, and injury mechanism serving as explanatory variables.
  
  
  RESULTS
  There was less neurologic disability in the unimmobilized Malaysian patients (OR 2.03; 95% CI 1.03-3.99; p = 0.04). This corresponds to a <2% chance that immobilization has any beneficial effect. Results were similar when the analysis was limited to patients with cervical injuries (OR 1.52; 95% CI 0.64-3.62; p = 0.34).
  
  
  CONCLUSIONS
  Out-of-hospital immobilization has little or no effect on neurologic outcome in patients with blunt spinal injuries.
authors.affiliation: Department of Emergency Medicine, University of New Mexico, School of Medicine, Albuquerque 87131-5246, USA. mhauswald@salud.unm.edu
authors.forename: M
authors.initials: M
authors.lastname: Hauswald
authors.forename: G
authors.initials: G
authors.lastname: Ong
authors.forename: D
authors.initials: D
authors.lastname: Tandberg
authors.forename: Z
authors.initials: Z
authors.lastname: Omar
mesh_terms: D000328:Adult; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007103:Immobilization; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000628:therapy; D013124:Spinal Injuries / Q000628:therapy; D014187:Transportation of Patients; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000628:therapy