title: The reliability of prehospital clinical evaluation for potential spinal injury is not affected by the mechanism of injury.
abstract: BACKGROUND
  Traditional EMS teaching identifies mechanism of injury as an important predictor of spinal injury. Clinical criteria to select patients for immobilization are being studied in Michigan and have been implemented in Maine. Maine requires automatic immobilization of patients with "a positive mechanism" clearly capable of producing spinal injury.
  
  
  OBJECTIVE
  To determine whether mechanism of injury affects the ability of clinical criteria to identify patients with spinal injury.
  
  
  METHODS
  In this multicenter prospective cohort study, EMS personnel completed a check-off data sheet for prehospital spine-immobilized patients. Data included mechanism of injury and yes/no determinations of the clinical criteria: altered mental status, neurologic deficit, evidence of intoxication, spinal pain or tenderness, and suspected extremity fracture. Hospital outcome data included confirmation of spinal injury and treatment required. Mechanisms of injury were tabulated and rates of spinal injury for each mechanism were calculated. The patients were divided into three different high-risk and low-risk groups.
  
  
  RESULTS
  Data were collected for 6,500 patients. There were 209 (3.2%) patients with spinal injuries identified. There were 1,058 patients with 100 (9.4%) injuries in the first high-risk mechanism group, and 5,423 patients with 109 (2%) injuries in the first low-risk group. Criteria identified 97 of 100 (97%) injuries in the high-risk group and 102 of 109 (94%) in the low-risk group. Two additional data divisions yielded identical results.
  
  
  CONCLUSIONS
  Mechanism of injury does not affect the ability of clinical criteria to predict spinal injury in this population.
authors.affiliation: University of Michigan/Saint Joseph Mercy Hospital Emergency Medicine Residency, Ann Arbor, USA. rdomeier@aol.com
authors.forename: R M
authors.initials: RM
authors.lastname: Domeier
authors.forename: R W
authors.initials: RW
authors.lastname: Evans
authors.forename: R A
authors.initials: RA
authors.lastname: Swor
authors.forename: J B
authors.initials: JB
authors.lastname: Hancock
authors.forename: W
authors.initials: W
authors.lastname: Fales
authors.forename: J
authors.initials: J
authors.lastname: Krohmer
authors.forename: S M
authors.initials: SM
authors.lastname: Frederiksen
authors.forename: M A
authors.initials: MA
authors.lastname: Shork
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007103:Immobilization; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D013124:Spinal Injuries / Q000145:classification / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D011795:Surveys and Questionnaires