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Immobilisering efter trauma: Retrospektiv studie av förekomsten av spinala skador
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
2015 (Swedish)Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
Abstract [sv]

Bakgrund: Immobilisering är en vedertagen omvårdnadsåtgärd inom dagens prehospitala traumavård, detta trots att det inte finns några randomiserade kontrollerade studier angående åtgärden. Många studier har dock visat att riskerna med immobilisering är många varför det är viktigt att undersöka omvårdnadshandlingen närmare.

Syfte: Syftet med studien var att undersöka förekomsten av radiologiskt fastställda spinala skador hos patienter som immobiliserats prehospitalt efter trauman, samt på vilka indikationer denna immobilisering gjordes.

Metod: En kvantitativ retrospektiv studie där 288 journaler granskades i ambulansens journalsystem MobiMed 3.0 och i sjukhusets journalsystem Cosmic. Därefter analyserades resultaten i SPSS deskriptivt och grafiskt, med chi2-test samt med oberoende t-test.

Resultat: Resultatet visade att av de 246 patienter som genomgått en radiologisk undersökning fanns en konstaterad spinal skada hos 48 patienter, vilket motsvarade cirka 17 %. Alla inkluderade patienter hade varit utsatta för trubbigt våld och den vanligaste indikationen för immobilisering var smärta/ömhet över kotpelaren. Medelåldern hos patienterna med spinala skador var signifikant högre än medelåldern hos de utan spinala skador och en signifikant skillnad fanns mellan patienterna med spinal skada och utan spinal skada och samtidig smärta/ömhet över kotpelaren.

Slutsats: Ett större antal patienter uppvisade skador i denna studie jämfört med tidigare studier, hos den stora majoriteten fanns dock inga spinala skador. Detta innebär att patienterna utsätts för en potentiellt onödig omvårdnadsåtgärd som är svagt vetenskapligt underbyggd och medför ett flertal risker. Fler studier inom området behövs för att kunna minska patienters potentiella lidande i och med att immobiliseras prehospitalt. 

Abstract [en]

Background: Spinal immobilization is an established practice in today’s prehospital trauma care. This even though there is a lack of randomized controlled studies regarding this practice. Many studies points to the risks regarding spinal immobilization why it is of importance to further examine the practice.

Aim: The aim of this study was to investigate the incidence of radiologically confirmed spinal injuries in patients immobilized after prehospital trauma and on what indications this immobilization was done

Method: A quantitative retrospective study of 288 medical records acquired from the ambulance medical record system Mobimed 3.0 and the hospital's medical record Cosmic were examined. The results were analyzed in SPSS descriptive and graphic, with chi2-test and independent t-test.

Result: The results show that of the 246 patients who underwent a radiological examination, 46 had a spinal injury, approximately 17 %. All of the included patients had been exposed to blunt trauma and the most common indication for immobilization was pain/tenderness over the spine. The mean age of the patients with spinal injuries was significantly higher than the mean age of those without spinal injuries. A significant difference was also found between patients with pain/tenderness over the spine and spinal injury and those without spinal injury.

Conclusion: A greater number of patients had a spinal injury in this study compared with previous studies, although the majority of the patients had no spinal injury. This means that the majority of the patients were exposed to a potentially unnecessary procedure that lacks scientifically evidence. More studies about immobilization are required to reduce the patients' potential suffering in connection with prehospital immobilization. 

Place, publisher, year, edition, pages
2015. , 39 p.
Keyword [en]
Immobilization, trauma, spinal cord injury, quality assurance
Keyword [sv]
Immobilisering, trauma, ryggradsskador, kvalitetssäkring
National Category
Nursing
Identifiers
URN: urn:nbn:se:uu:diva-254149OAI: oai:DiVA.org:uu-254149DiVA: diva2:817268
Subject / course
Caring Sciences
Educational program
Specialistsjuksköterskeprogrammet med inriktning mot ambulanssjukvård
Supervisors
Examiners
Available from: 2015-06-05 Created: 2015-06-04 Last updated: 2015-06-05Bibliographically approved

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