Abstract

Background: Despite the common application of pre-clinical immobilisation in trauma patients for many years, the existing evidence for this intervention is still weak. The need for pre-clinical immobilisation and applying the right immobilisation procedures on the right trauma patients is still controversial in the scientific literature.

Objectives: This systematic review aims to compare different outcomes to answer whether the pre-clinical immobilisation of trauma patients is more effective than no pre-clinical Immobilisation and analyses it critically. Methods: A systematic literature search was conducted according to the PRISMA criteria in the PubMed and EMBASE databases with meta-analyses. We searched for randomized controlled trials (RCTs) and no randomized studies of intervention (NRSIs, both prospective and retrospective studies) comparing two different groups of trauma patients (pre-clinical immobilisation vs no pre-clinical immobilisation). We set no time or language limitations. Two reviewers screened the title/abstracts and the full-texts independently. We resolved any conflicts with discussion.

Results: We identified 2,726 studies from PubMed and EMBASE. After double stage screening, a total of 13 studies were included in the systematic review. Both spinal injuries (OR= 3.69, 95% CI from 1.82 to 7.49) and neurological deficits (OR= 2.67, 95% CI from 1.15 to 6.18) occurred in the pre-clinical immobilized patients significantly more often than non-immobilized. We found higher mortality (OR= 1.97, 95% CI from 1.12 to 3.46) and six times higher side effects (OR= 6.01, 95% CI from 2.880 to 12.91) in the group of pre-clinical immobilisation compared to the control.

Conclusion: Pre-clinical immobilisation seems unable to reduce the neurological deficits, mortality, or spine injuries in trauma patients than no-immobilisation. The side-effects of the intervention are higher than the control. The quality of evidence is low. Regarding this topic, there is a critical need for primary studies in general and randomized controlled trials in specific.