title: A Retrospective Study of Five Clinical Criteria and One Age Criterion for Selective Prehospital Spinal Immobilization.
abstract: Full spinal immobilization of blunt trauma victims is a widely accepted prehospital measure, applied in order to prevent (further) damage to the spinal cord. However, looking at the marginal evidence that exists for the effectiveness of spinal immobilization, and the growing evidence for the negative effects following immobilization, a more selective protocol might be able to reduce possible morbidity and mortality as good as the present prehospital immobilization protocol. In a retrospective study, the sensitivity of a selective prehospital immobilization protocol that adds an age criterion to five clinical spine clearance criteria is examined.
  
  
  METHODS
  Based on ICD-9 codes, all patients admitted to the trauma center diagnosed with spinal fractures with or without spinal damage were identified. The sensitivity of the combination of five clinical criteria (reduced awareness, evidence of intoxication, neurological deficit, pain of the spine on palpation, (significant) distracting injury) and an age criterion (65 years or older at time of accident) was determined. If one or more criteria were positive, standard full immobilization would be indicated. The other patients would not have been immobilized.
  
  
  RESULTS
  A total of 238 blunt trauma victims primarily admitted to the trauma center were included for this study. Median age of the included patients was 39 years (range 5-98), with 32.8% female. A total of 236 had at least one positive criterion (sensitivity 99.2%). The two missed patients were male, 40 and 41 years old. Radiology showed a small fissure in the arch of C2, and a transverse process fracture of L3, respectively. Both patients were discharged the next day without complications or medical interventions.
  
  
  CONCLUSIONS
  In this retrospective study, a selective protocol based on clinical criteria instead of trauma mechanism showed 99.2% sensitivity for spinal fractures with or without spinal cord damage. Based on this study and the current controversy surrounding spinal immobilization, a prospective study should be considered to evaluate the five clinical criteria and one age criterion in the prehospital setting.
authors.affiliation: Trauma Unit Department of Surgery, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands. p.fungkonjin@amc.uva.nl.|Trauma Unit Department of Surgery, Academic Medical Center-University of Amsterdam, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. p.fungkonjin@amc.uva.nl.
authors.forename: Ping Fung Kon
authors.initials: PF
authors.lastname: Jin
authors.affiliation: Trauma Unit Department of Surgery, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Johann Carel
authors.initials: JC
authors.lastname: Goslings
authors.affiliation: Trauma Unit Department of Surgery, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Luitse
authors.affiliation: Trauma Unit Department of Surgery, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Kees Jan
authors.initials: KJ
authors.lastname: Ponsen
keywords: Immobilization; Overtriage; Prehospital care; Spinal injuries; Spine; Triage