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A Descriptive Analysis of Traction Splint Utilization and IV Analgesia by Emergency Medical Services

Published online by Cambridge University Press:  15 August 2017

Joshua Nackenson Open the ORCID record for Joshua Nackenson [Opens in a new window] ,
Amado A. Baez  and
Jonathan P. Meizoso
Joshua Nackenson*
Affiliation:
University of Texas Southwestern Medical Center Department of Emergency Medicine, Dallas, TexasUSA
Amado A. Baez
Affiliation:
Kings County Hospital/SUNY Downstate Department of Emergency Medicine, Brooklyn, New YorkUSA
Jonathan P. Meizoso
Affiliation:
University of Miami/Jackson Memorial Medical Center, Ryder Trauma Center, DeWitt Daughtry Family Department of Surgery, Miami, FloridaUSA
*
Correspondence: Joshua Nackenson, MD, NRP University of Texas Southwestern Medical Center Department of Emergency Medicine Dallas, Texas USA E-mail: joshua.nackenson@gmail.com
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Abstract

Study Objectives

Traction splinting has been the prehospital treatment of midshaft femur fracture as early as the battlefield of the First World War (1914-1918). This study is the assessment of these injuries and the utilization of a traction splint (TS) in blunt and penetrating trauma, as well as intravenous (IV) analgesia utilization by Emergency Medical Services (EMS) in Miami, Florida (USA).

Methods

This is a retrospective study of patients who sustained a midshaft femur fracture in the absence of multiple other severe injuries or severe physiologic derangement, as defined by an injury severity score (ISS) <20 and a triage revised trauma score (T-RTS)≥10, who presented to an urban, Level 1 trauma center between September 2008 and September 2013. The EMS patient care reports were assessed for physical exam findings and treatment modality. Data were analyzed descriptively and statistical differences were assessed using odds ratios and Z-score with significance set at P≤.05.

Results

There were 170 patients studied in the cohort. The most common physical exam finding was a deformity +/- shortening and rotation in 136 patients (80.0%), followed by gunshot wound (GSW) in 22 patients (13.0%), pain or tenderness in four patients (2.4%), and no findings consistent with femur fracture in three patients (1.7%). The population was dichotomized between trauma type: blunt versus penetrating. Of 134 blunt trauma patients, 50 (37.0%) were immobilized in traction, and of the 36 penetrating trauma victims, one (2.7%) was immobilized in traction. Statistically significant differences were found in the application of a TS in blunt trauma when compared to penetrating trauma (OR=20.83; 95% CI, 2.77-156.8; P <.001). Intravenous analgesia was administered to treat pain in only 35 (22.0%) of the patients who had obtainable IV access. Of these patients, victims of blunt trauma were more likely to receive IV analgesia (OR=6.23; 95% CI, 1.42-27.41; P=.0067).

Conclusion

Although signs of femur fracture are recognized in the majority of cases of midshaft femur fracture, only 30% of patients were immobilized using a TS. Statistically significant differences were found in the utilization of a TS and IV analgesia administration in the setting of blunt trauma when compared to penetrating trauma.

NackensonJ, BaezAA, MeizosoJP. A Descriptive Analysis of Traction Splint Utilization and IV Analgesia by Emergency Medical Services.Prehosp Disaster Med. 2017;32(6):631–635.

Keywords

EMSextremity traumafemur fractureprehospitaltraction splint
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 32 , Issue 6 , December 2017 , pp. 631 - 635
Copyright
© World Association for Disaster and Emergency Medicine 2017 

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Footnotes

Conflicts of interest: none

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