INTRODUCTION 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 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). METHODS A retrospective analysis of multi-institutional data from the Maryland Institute for Emergency Medical Service Systems (MIEMSS) State Trauma Registry was performed. The analysis included all ten trauma centers in the state of Maryland from July 1995 through June 1998. A patient was considered to have theoretically benefited from immobilization if he had less than complete neurological deficits in the presence of an unstable vertebral column, as determined by the need for a vertebral column stabilization procedure while in the hospital. RESULTS There were 4247 GSW patients, with 1000 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%; 95% CI, -0.077% to 0.48%) required operative vertebral column stabilization, and six others required other spinal operations for decompression and/or foreign body removal. CONCLUSIONS The rarity of an unstable fracture secondary to GSW may well render mandatory thoracolumbar immobilization policy as one with limited benefits but potential risks. The role of formal thoracolumbar immobilization for GSW patients should be re-examined.
Learning Objectives: 1. Recognize that the value of some of the EMS procedures have not been tested in an evidence-based manner to examine their influence on outcome, given their negative demand on time. 2. Discuss the risks and benefits associated with a particular EMS procedure, namely, thoracolumbar immobilization for gunshot wound patients. 3. Extend the lessons of this project to other EMS procedures by applying similar risk-benefit assessment
Keywords: EMS/Trauma, Treatment Outcomes
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.