Document Detail


Can EMS providers adequately assess trauma patients for cervical spinal injury?
MedLine Citation:
PMID:  9737405     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine whether EMS providers can accurately apply the clinical criteria for clearing cervical spines in trauma patients. METHODS: EMS providers completed a data form based on their initial assessments of all adult trauma patients for whom the mechanism of injury indicated immobilization. Data collected included the presence or absence of: neck pain/tenderness; altered mental status; history of loss of consciousness; drug/alcohol use; neurologic deficit; and other painful/distracting injury. After transport to the ED, emergency physicians (EPs) completed an identical data form based on their assessments. Immobilization was considered to be indicated if any one of the six criteria was present. The EPs and EMS providers were blinded to each other's assessments. Agreement between the EP and EMS assessments was analyzed using the kappa statistic. RESULTS: Five-hundred seventy-three patients were included in the study. The EP and EMS assessments matched in 78.7% (n = 451) of the cases. There were 44 (7.7%) patients for whom EP assessment indicated immobilization, but the EMS assessment did not. The kappa for the individual components of the assessments ranged from 0.35 to 0.81, with the kappa for the decision to immobilize being 0.48. The EMS providers' assessments were generally more conservative than the EPs'. CONCLUSION: EMS and EP assessments to rule out cervical spinal injury have moderate to substantial agreement. However, the authors recommend that systems allowing EMS providers to decide whether to immobilize patients should follow those patients closely to ensure appropriate care and to provide immediate feedback to the EMS providers.
Authors:
L H Brown; J E Gough; W B Simonds
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors     Volume:  2     ISSN:  1090-3127     ISO Abbreviation:  Prehosp Emerg Care     Publication Date:    1998 Jan-Mar
Date Detail:
Created Date:  1998-11-24     Completed Date:  1998-11-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9703530     Medline TA:  Prehosp Emerg Care     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  33-6     Citation Subset:  IM    
Affiliation:
Department of Emergency Medicine, East Carolina University School of Medicine, Greenville, NC, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Cervical Vertebrae / injuries*
Clinical Competence*
Confounding Factors (Epidemiology)
Emergency Medical Technicians / standards*
Emergency Treatment / methods,  standards
Humans
Immobilization
Physicians / standards*
Prospective Studies
Spinal Injuries / diagnosis*
Trauma Severity Indices
United States

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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