Multicenter prospective validation of prehospital clinical spinal clearance criteria.
BACKGROUND
Spine immobilization is one of the most frequently performed prehospital procedures. If trauma patients without significant risk for spine injury complications can be identified, spine immobilization could be selectively performed. The purpose of this study was to evaluate five prehospital clinical criteria-altered mental status, neurologic deficit, spine pain or tenderness, evidence of intoxication, or suspected extremity fracture-the absence of which identify prehospital trauma patients without a significant spine injury.


METHODS
Prospectively collected emergency medical services data items included the above-listed criteria. Outcome data include spine fracture or cord injury, and also the level and management of injuries.


RESULTS
A total of 295 patients with spine injuries were present in 8,975 (3.3%) cases. Spine injury was identified by the prehospital criteria in 280 of 295 (94.9%) injured patients. The criteria missed 15 patients. Thirteen of 15 had stable injuries, the majority of which were stable compression or vertebral process injuries. The remaining two would have been captured by more accurate prehospital evaluation.


CONCLUSIONS
Absence of the study criteria may form the basis of a prehospital protocol that could be used to identify trauma patients who may safely have rigid spine immobilization withheld. Evaluation of such a protocol in practice should be performed.
Domeier
Robert M
RM
University of Michigan/Saint Joseph Mercy Hospital Emergency Medicine Residency Program, University of Michigan, School of Public Health, Ann Arbor, USA. rdomeier@aol.com
Swor
Robert A
RA
Evans
Rawden W
RW
Hancock
J Brian
JB
Fales
William
W
Krohmer
Jon
J
Frederiksen
Shirley M
SM
Rivera-Rivera
Edgardo J
EJ
Schork
M Anthony
MA
D000328:Adult; D000552:Ambulances; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D005260:Female; D006801:Humans; D007103:Immobilization; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013119:Spinal Cord Injuries / Q000150:complications; D013124:Spinal Injuries / Q000150:complications / Q000175:diagnosis* / Q000628:therapy