Validity of Clinical Spine Clearance Criteria for Selective Pre-hospital Spine Immobilization.
- Author:
Yu Jin KIM
1
;
Ju Ok PARK
;
Ki Ok AHN
;
Kyoung Jun SONG
;
Sang Do SHIN
;
Gil Joon SUH
Author Information
1. Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea. shinsangdo@medimail.co.kr
- Publication Type:Randomized Controlled Trial ; Original Article
- Keywords:
Emergency Medical Services;
Spinal Injuries;
Immobilization
- MeSH:
Diagnosis;
Emergencies;
Emergency Medical Services;
Emergency Medical Technicians;
Extremities;
Hand;
Humans;
Immobilization*;
Korea;
Neck Pain;
Prospective Studies;
Sensitivity and Specificity;
Spinal Cord Injuries;
Spinal Fractures;
Spinal Injuries;
Spine*
- From:Journal of the Korean Society of Emergency Medicine
2006;17(4):300-307
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: We aimed to validate clinical spine clearance criteria for selective pre-hospital spine immobilization and to evaluate the appropriateness, according to those criteria, of spine immobilizations currently being performed in the field. METHODS: This was a 4-month double blind prospective study. Targets were patients with trauma who were transported to a regional emergency center by emergency medical technicians (EMTs). Independent hospital EMTs specified that a spine immobilization was necessary if patients were positive for any of the following 8 criteria: (1) altered mental status, (2) evidence of intoxication, (3) neurological deficit, (4) suspected proximal extremity fracture, (5) cervical pain, (6) cervical tenderness, (7) thoraco/lumbar pain, or (8) thoraco/lumbar tenderness. The appropriateness of the immobilization was evaluated afterward on the basis of the final diagnosis. RESULTS: The study collected data on 171 trauma victims from among 1,135 eligible patients. 10 out of 171 patients (5.1%) received a final diagnosis of spinal fracture or spinal cord injury, and all of them had been assessed according to the criteria as requiring spinal immobilization. Sensitivity, specificity, positive predictive value, and negative predictive value were 100.0%, 44.7%, 10.1%, and 100.0%, respectively. On the other hand, among the 99 patients eventually judged to have required immobilization, 54 patients were not immobilized (54/99 = 54.5%) and were therefore underprotected, and among the 72 patients eventually judged to not require immobilization, 11 were over-protected (11/72 =15.3%). CONCLUSION : Clinical spine clearance criteria were useful both for judging the necessity of pre-hospital spine immobilization and for predicting spinal injuries. If these criteria can be applied to the emergency medical service system of Korea, it will contribute to the performing of appropriate spine immobilization.
