Correction to Spine Immobilization in Penetrating Trauma: More Harm Than Good

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Also posted over at Rogue Medic (now at EMS Blogs) and at Research Blogging.

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The most recent EMS Research podcast is available – Spine Immobilization in Penetrating Trauma: More Harm Than Good?: EMS Research Episode 6.

I let my biases get the better of me when I wrote about this earlier.^[1]

While I spent a significant portion of that review explaining why evidence of benefit was not present in this study, I ignored the problems with the data when the authors concluded that there was harm.

That was a mistake on my part. While I do believe that harm is likely, this study does not provide evidence to support that belief.

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The study uses data from the NTDB (National Trauma Data Bank®). The problem is that the NTDB does not appear to provide reliable data. I described a lot of the problems in posts about the use of the NTDB to examine the effect of prehospital fluid on survival of trauma patients.^[2] I will not repeat that here.

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One example is this –

The percentage of spine immobilized patients with penetrating trauma is small. This suggests an appropriate lack of immobilization, consistent with PHTLS (PreHospital Trauma Life Support) guidelines. The total percentage of spine immobilized patients is also small – much smaller than anyone should expect in any EMS (Emergency Medical Services) system in the US.

How many of the trauma patients were fully immobilized, but did not have the data entered accurately?

Penetrating Trauma -

4.3% spinal immobilization.^[3]

All Trauma -

8.1% spinal immobilization.^[4]

Moving the decimal place one digit to the right (81%) might still underestimate the actual percentage of all trauma patients immobilized. If the data may be off by more than a factor of ten, can we draw any conclusions from this paper?

What needs to be done to improve the quality of the data being recorded by the NTDB?

Go listen to the podcast.

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I apologize for the misleading post. I looked at my notes on the paper and I had the problems noted, but when it came to writing about the study, I ignored the problems where they supported my biases.

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Footnotes:

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^[1] Spine Immobilization in Penetrating Trauma: More Harm Than Good?
Rogue Medic
01/21/2010
Article

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^[2] Prehospital Intravenous Fluid Administration is Associated With Higher Mortality in Trauma Patients – Part I, Part II, and Part III
Rogue Medic

02/20/2011
Part I

02/22/2011
Part II

03/01/2011
Part III

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^[3] Spine immobilization in penetrating trauma: more harm than good?
Haut ER, Kalish BT, Efron DT, Haider AH, Stevens KA, Kieninger AN, Cornwell EE 3rd, Chang DC.
J Trauma. 2010 Jan;68(1):115-20; discussion 120-1.
PMID: 20065766 [PubMed - in process]

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^[4] Prehospital Intravenous Fluid Administration is Associated With Higher Mortality in Trauma Patients: A National Trauma Data Bank Analysis.
Haut ER, Kalish BT, Cotton BA, Efron DT, Haider AH, Stevens KA, Kieninger AN, Cornwell EE 3rd, Chang DC.
Ann Surg. 2010 Dec 20. [Epub ahead of print]
PMID: 21178760 [PubMed - as supplied by publisher]

Full Text in PDF format from www.medicalscg

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