The impact of spinal immobilization in patients with penetrating injuries in prehospital settings: a systematic review

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Abstract Purpose: Penetrating injuries, such as gunshot or stab wounds may cause spinal cord injuries and require prehospital spinal immobilization (PHSI) to stabilize the spine. However, the use of PHSI in penetrating injuries remains controversial. This systematic review aimed to investigate the efficacy of prehospital PHSI in patients with penetrating trauma. Methods: We systematically searched Google Scholar, Medline (PubMed), The Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE between January 2000 and January 2021. All studies in English that assessed PHSI in patients (>16 years) with penetrating injuries were included. Quality and risk of bias assessments were performed using the modified Newcastle-Ottawa scale. A narrative synthesis was conducted as meta-analysis was not possible due to the lack of quantitative data. Results: Our search identified 928 studies but only 6 met our inclusion and exclusion criteria. All of the included studies were conducted in the US and the number of patients ranged from 156-75,567 over 3-9 study years. The majority of patients were gunshot or stab wounds. Three studies demonstrated an increased risk of mortality with spinal collars whilst the remaining three studies failed to show any benefits or the benefits remained unproven. All studies were retrospective studies with some risks of bias. Conclusion: This review highlights that the evidence from the literature of PHSI in penetrating trauma outweigh its benefits; thus, its use is highly discouraged in penetrating spinal trauma. However, further high-quality research is necessary to reach definite conclusions and to possibly identify suitable alternatives to PHSI for penetrating trauma. Keywords: Penetrating injury/trauma; prehospital; spinal immobilization; spinal cord.