title: Prospective performance assessment of an out-of-hospital protocol for selective spine immobilization using clinical spine clearance criteria.
abstract: OBJECTIVE
  We determine whether the use of an emergency medical services (EMS) protocol for selective spine immobilization would result in appropriate immobilization without spinal cord injury associated with nonimmobilization.
  
  
  METHODS
  A 4-year prospective study examined EMS and hospital records for patients after the implementation of an EMS protocol for selective spine immobilization. EMS personnel were trained to perform and document a spine injury assessment for out-of-hospital trauma patients with a mechanism of injury judged sufficient to cause a spine injury. The assessment included these clinical criteria: altered mental status, evidence of intoxication, neurologic deficit, suspected extremity fracture, and spine pain or tenderness. The protocol required immobilization for patients with a positive assessment on any of those criteria. Outcome characteristics included the presence or absence of spine injury and spine injury management.
  
  
  RESULTS
  The study collected data on 13,483 patients; 126 of the patients were subsequently excluded from the study because of incomplete data, leaving a study sample of 13,357 patients with complete data. Spine injuries were confirmed in the hospital records for 3% (n=415) of patients, including 50 patients with cord injuries and 128 patients with cervical injuries. Sensitivity of the EMS protocol was 92% (95% confidence interval [CI] 89.4 to 94.6%) resulting in nonimmobilization of 8% of the patients with spine injuries (33 of 415). None of the nonimmobilized patients sustained cord injuries. The specificity was 40% (95% CI 38.9 to 40.5%).
  
  
  CONCLUSIONS
  The use of our selective immobilization protocol resulted in spine immobilization for most patients with spine injury without causing harm in cases in which spine immobilization was withheld.
authors.affiliation: The University of Michigan/Saint Joseph Mercy Hospital Emergency Medicine, Ann Arbor, MI, USA. rdomeier@aol.com
authors.forename: Robert M
authors.initials: RM
authors.lastname: Domeier
authors.forename: Shirley M
authors.initials: SM
authors.lastname: Frederiksen
authors.forename: Kathy
authors.initials: K
authors.lastname: Welch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity; D013119:Spinal Cord Injuries / Q000209:etiology / Q000517:prevention & control; D016103:Spinal Fractures / Q000628:therapy; D013124:Spinal Injuries / Q000150:complications / Q000628:therapy*; D015599:Trauma Severity Indices; D016896:Treatment Outcome