The characteristics and pre-hospital management of blunt trauma patients with suspected spinal column injuries: a retrospective observational study.
BACKGROUND
Pre-hospital spinal immobilisation by emergency medical services (EMS) staff is currently the standard of care in cases of suspected spinal column injuries. There is, however, a lack of data on the characteristics of patients who received spinal immobilisation during the pre-hospital phase and on the adverse effects of immobilisation. The objectives of this study were threefold. First, we determined the pre-hospital characteristics of blunt trauma patients with suspected spinal column injuries who were immobilised by EMS staff. Second, we assessed the choices made by EMS staff regarding spinal immobilisation techniques and reasons for immobilisation. Third, we researched the possible adverse effects of immobilisation.


METHODS
A retrospective observational study in a cohort of blunt trauma patients.


METHODS
Data of blunt trauma patients with suspected spinal column injuries were collected from one EMS organisation between January 2008 and January 2013. Coded data and free text notes were analysed.


RESULTS
A total of 1082 patients were included in this study. Spinal immobilisation was applied in 96.3 % of the patients based on valid pre-hospital criteria. In 2.1 % of the patients immobilisation was not based on valid criteria. Data of 1.6 % patients were missing. Main reasons for spinal immobilisation were posterior midline spinal tenderness (37.2 % of patients) and painful distracting injuries (13.5 % of patients). Spinal cord injury (SCI) was suspected in 5.7 % of the patients with posterior midline spinal tenderness. A total of 15.8 % patients were immobilised using non-standard methods. The reason for departure from the standard method was explained for 3 % of these patients. Reported adverse effects included pain (n = 10, 0.9 %,); shortness of breath (n = 3, 0.3 %); combativeness or anxiety (n = 6, 0.6 %); and worsening of pain when supine (n = 1, 0.1 %).


CONCLUSIONS
Spinal immobilisation was applied in 96.3 % of all included patients based on pre-hospital criteria. We found that consensus among EMS staff on how to interpret the criterion 'distracting injury' was lacking. Furthermore, the adverse effects of spinal immobilisation were incompletely documented in pre-hospital care reports. To provide validated information on potential symptoms of SCI, a uniform EMS scoring system for motoric assessment should be developed.
School of Nursing and Health, University Medical Centre Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands. j.oosterwold@umcg.nl.|Ambulance Department, University Medical Centre Groningen, Roden, The Netherlands. j.oosterwold@umcg.nl.
J T
JT
Oosterwold
Ambulance Department, University Medical Centre Groningen, Roden, The Netherlands.
D C
DC
Sagel
Ambulance Emergency Medical Service Gelderland-Zuid, Nijmegen, The Netherlands.
P M
PM
van Grunsven
Department of Orthopaedic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
M
M
Holla
Department of Rehabilitation, Nursing Science and Sports, University Medical Centre Utrecht, Utrecht, The Netherlands.|Faculty of Medicine, Clinical Health Sciences, Utrecht University, Utrecht, The Netherlands.
J
J
de Man-van Ginkel
Eastern Regional Emergency Healthcare Network & IQ Scientific Centre for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands.|Department of Critical and Emergency Care, Knowledge Centre of Sustainable Healthcare, HAN University of Applied Sciences, Nijmegen, The Netherlands.
S
S
Berben
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007103:Immobilization / Q000009:adverse effects; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010147:Pain Measurement; D012189:Retrospective Studies; D012737:Sex Factors; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000628:therapy*; D013124:Spinal Injuries / Q000453:epidemiology / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000628:therapy; D055815:Young Adult
Blunt trauma; Emergency medical services; Pre-hospital; Retrospective observational study; Spinal column injury; Spinal immobilisation