NURS 6052 Module 3 Week 5 Assignment; Evidence-Based Project, Part 2, Advanced Levels of Clinical Inquiry and Systematic Reviews

NURS 6052 Student Name Submission Date EBP:Spinal Immobilization 1 Spinal Immobilization has remained an integral part of most emergency medical services protocols despite the lack of evidence of efficacy and concern for associated complications, it was just what we were suppose to do (Velopulos, 2018). 2 PICO(T) QUESTION DEVELOPMENT In penetrating trauma patients, does spinal immobilization increase the risk of morbidity or mortality? I developed my PICO(T) question based on my clinical interest in the evidence based practices related to trauma patients. I designed the question based upon the PICO(T) format. PICO(T) format is patient population, issue of interest, comparison intervention, outcome and time frame. 3 Medline with Fulltext CINAHL plus with full text Pubmed.gov TRIP database Research Databases 4 1. Purvis, T. A., Carlin, B., & Driscoll, P. (2017). The definite risks and questionable benefits of liberal pre- hospital spinal immobilisation. The American Journal of Emergency Medicine, 35(6), 860-866. doi:10.1016/j.ajem. 2017.01.045 4. Kwan, I., Bunn, F., & Roberts, I. G. (2001). Spinal immobilisation for trauma patients. The Cochrane Database of Systematic Reviews, 2. doi:10.1002/14651858.cd002803 2. Long, Brit, et al. “Utility of Spinal Immobilization in Patients With Penetrating Trauma.” Academic Emergency Medicine, vol. 27, no. 1, 2019, pp. 69–70. CINAHL Plus with Full Text, doi:10.1111/acem.13852. 3. Velopulos, Catherine G., et al. “Prehospital Spine Immobilization/Spinal Motion Restriction in Penetrating Trauma.” Journal of Trauma and Acute Care Surgery, vol. 84, no. 5, 2018, pp. 736–744. Trip Database, doi:10.1097/ta.0000000000001764. 5 6 Strengths A review of the literature was carried out by two independent assessors using different databases including medline, pubmed, embase and the cochrane library. The evidence was then run through a checklist derived from SIGN and CASP guidelines, as well as Crombie’s guide to critical appraisal. The strengths of the research methodologies is this article used multiple types of research to support their endpoint. Strong research article includes studies that used high amount of research of patients studied. In regards to reliability there was a confidence interval of 95% with a relative risk of 2.4 (Long, et al, 2019). The reliability of this study has a confidence interval of 1.07-5.41 and relative risk of 2.4 for increased mortality associated with spine immobilization (Velopulos, et al, 2018). The strengths of this article as it is broken down and organized in an easy understandable way. The strengths of this article include identification of the need for randomised control trials in trauma patients to establish the relative effectiveness of alternative strategies for spinal immobilization to provide evidence backed alternative to spinal immobilization. A randomized control trial is the best research design when providing information about cause and effect relationships. The highest quality of research are those of a systematic review of a large quantity of high-quality randomized control trials of similar design (Melnyk & Fineout-Overholt, 2019). References: Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: a guide to best practice (4th ed.). Wolters Kluwer.