Prolonged use of spinal precautions is associated with increased morbidity in the trauma patient. Issue 2 (February 2020) - MacCallum, Katherine P.
Highlights: Prolonged immobilization for greater than 72 h following blunt spinal trauma is associated with increased rates of hospital-associated morbidities. Focus should be on prompt, definitive care and early mobilization. The majority of patients with spinal fractures following blunt trauma do not require operative intervention, yet even definitive, non-surgical management may be delayed. This study showed a correlation between incidence of pneumonia, urinary tract infection, and venous thromboembolic events and patients in spinal precautions for longer than 72 h. Coordination of care between the trauma, orthopaedic, and rehabilation teams is essential to ensuring the best outcomes for patients who have suffered blunt spinal injuries. Abstract: Background: Patients who experience traumatic spine injuries remain in spinal precautions (SP) to minimize the risk of devastating cord injury while awaiting definitive management. This study examines the incidence of pneumonia (PNA), urinary tract infection (UTI), deep vein thrombosis (DVT), or pulmonary embolism (PE) in this population. Study design: From 2014 to 2016, 344 patients aged 18 and older with spinal column injuries were identified in a prospectively-collected registry at an urban, level 1 trauma center. After exclusion criteria, 330 patients were reviewed and the following were analyzed: demographics, duration of SP, time to intervention, and rates of PNA, UTI, and DVT or PE. Those patients kept in SP for ≤ 72 h ("prolonged") were compared to patients maintained in SP for > 72 h ("early"). Results: Mean age was 54.6 years (SD, 21.7), median Injury Severity Score (ISS) 10 (IQR, 5–17). The median SP was 4.0 (IQR, 3.0–6.0) days. Fifty-eight (17.6%) patients underwent fixation and 170 (51.5%) received a brace. 102 (30.9%) patients initially awaiting a brace were cleared after MRI. 93 (28.2) patients suffered one of the tracked complications; 51 (15.5%) developed PNA, 35 (10.6%) UTI, 23 (7.0%) DVT, and 5 (1.5%) PE. Rate of overall complications between patients with SP ≤ 72 h versus patients with SP > 72 h was statistically significant (20.5% vs 34.6%, p = 0.005) as was the incidence of UTI (14.5 vs 6.0, p = 0.012). Conclusion: Prolonged SP (>72 h) is associated with increased rates of immobility-associated morbidities. Focus should be on prompt, definitive care and early mobilization. Level of Evidence: III Retrospective review of prospectively-collected data