Validity of Clinical Spine Clearance Criteria for Selective Pre-hospital Spine Immobilization

Kim, Yu Jin; Park, Ju Ok; Ahn, Ki Ok; Song, Kyoung Jun; Shin, Sang Do; Suh, Gil Joon

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.