Hastane Öncesi Acil Sağlık Hizmetlerinde Travmalı Hastalarda Spinal İmmobilizasyon Uygulamasının Retrospektif Değerlendirilmesi – Seçici Kriterlere Yeni Katkılar

Öz

Amaç: Çalışmanın amacı hastane öncesi acil sağlık hizmetleri kapsamında travma hastalarında spinal immobilizasyon uygulanmasını retrospektif olarak değerlendirmek ve spinal immobilizasyon uygulaması için seçici kriterlerin geliştirilmesi ihtiyacını eleştirel olarak incelemektir. Yöntem: Bu retrospektif kohort çalışması, 1 Ocak 2019 ile 31 Aralık 2022 tarihleri arasında Türkiye'nin bir ilinde hastane öncesi acil sağlık hizmeti alan travma hastaları üzerinde yürütülmüştür. Veriler tıbbi kayıtlardan sistematik olarak çıkarılmış ve istatistiksel analiz SPSS sürüm 26.0 kullanılarak gerçekleştirilmiştir. Sürekli değişkenlerin eşleştirilmiş karşılaştırmaları için Wilcoxon işaretli sıra testi uygulanırken, kategorik değişkenlerin bağımsız gruplar arasındaki dağılımını değerlendirmek için Ki-kare testi kullanılmıştır. Anlamlılık düzeyi p<0,05 olarak belirlenmiştir. Bulgular: Kohort 7.860 travma hastasından oluşmuştur. Hastaların %36,2'sinde spinal immobilizasyon uygulanmıştır. Spinal immobilizasyon uygulanan hastaların %13,0'ına omurilik yaralanması teşhisi konulmuştur. Ancak ildeki en büyük travma hastanesinin acil servisinde omurilik yaralanması teşhisi konulan hastaların %25,2'sine hastane öncesi aşamada spinal immobilizasyonun uygulandığı görülmüştür. Omurilik yaralanmaları özellikle, iş kazalarının %9,5'inde, trafik kazalarının %7,6'sında, kırmızı triyaj kodu olarak sınıflandırılan hastaların %17,6'sında ve Glasgow Koma Skalası skoru ≤14 olanların %13,7'sinde meydana gelmiştir. Sonuç: Spinal immobilizasyon travma hastalarının önemli bir kısmında uygulansa da, özellikle doğrulanmış omurilik yaralanması vakalarında, uygulamasında kritik bir boşluk bulunmaktadır. Bulgular, özellikle düşük Glasgow Koma Skalası puanlarına sahip hastalar ve iş kazalarına karışanlar gibi yüksek riskli gruplar için spinal immobilizasyon için kanıta dayalı, seçici kriterler oluşturmanın acil ihtiyacını vurgulamaktadır. Spinal immobilizasyon uygulamalarını optimize etmek için klinik faktörleri, travma mekanizmalarını ve triyaj sınıflandırmasını entegre eden bir protokol geliştirmek için daha fazla araştırma gerekmektedir.

Anahtar Kelimeler

• Hastane Öncesi
• Travma
• İmmobilizasyon
• Omurilik yaralanması

RETROSPECTIVE EVALUATION OF SPINAL IMMOBILIZATION IN TRAUMA PATIENTS IN PREHOSPITAL EMERGENCY MEDICAL SERVICES- NEW CONTRIBUTIONS TO SELECTIVE CRITERIA

Öz

Objective: The study aims to retrospectively evaluate the application of spinal immobilization in trauma patients within prehospital emergency medical services (PH-EMS) and to critically examine the need for refining selective criteria for its implementation. Methods: This retrospective cohort study was conducted on trauma patients who received PH-EMS between January 1, 2019, and December 31, 2022, in a province of Turkey. Data were systematically extracted from medical records and statistical analysis was performed using SPSS version 26.0. The Wilcoxon signed-rank test was applied for paired comparisons of continuous variables, while the Chi-square test was employed to evaluate the distribution of categorical variables between independent groups. A significance level of p<0.05 was set. Results: The cohort comprised 7,860 trauma patients. Spinal immobilization was performed in 36.2% of cases, of which 13.0% were diagnosed with spinal cord injuries (SCI). However, 25.2% of patients who were ultimately diagnosed with SCI in the largest hospital in province emergency department had not received spinal immobilization during the prehospital phase. Notably, SCI occurred in 9.5% of occupational accidents, 7.6% of traffic-related trauma, 17.6% of patients classified as red triage, and 13.7% of those with a Glasgow Coma Scale (GCS) score ≤14. Conclusions: While spinal immobilization is implemented in a considerable proportion of trauma patients, there remains a critical gap in its application, particularly in cases with confirmed SCI. The findings highlight the urgent need to establish evidence-based, selective criteria for spinal immobilization, especially for high-risk groups such as patients with low GCS scores and those involved in occupational accidents. Further research is required to develop a protocol that integrates clinical factors, trauma mechanisms, and triage classification to optimize spinal immobilization practices.

Anahtar Kelimeler

• Prehospital
• Spinal Cord Injury
• Trauma
• Immobilization

Kaynakça

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