Clinical Clearance of Spinal Immobilization in the Air Medical Environment: A Feasibility Study

To analyze trauma patients not requiring spinal immobilization, various decision algorithms has been developed for prehospital setting use. There has been no study of algorithm application feasibility in the air medical transportation environment. Study eligibility was open to all adult patients ages 16 and over transported to three Level I trauma centers. A data collection sheet was completed by medical crews during transportation which was later used to determine the eligibility of the transported patient for spinal clearance based on the absence of all of the following clinical findings: (1) abnormal consciousness level; (2) intoxication evidence; (3) distracting painful injury; (4) spinal pain or tenderness or (5) abnormal neurologic examination. Outcomes were (1) proportion of potential spinal clearance eligibility among transported patients; and (2) spinal injury prediction ability of the algorithm. The study had 329 patients enrolled. Twelve of the 49 who had spinal injuries were considered unstable. The deferring spinal immobilization criteria was met by only 40 patients; of these, four had spinal fractures. The algorithm's specificity was 16% and sensitivity was 90%. The authors conclude that spinal immobilization clearance during air medical transportation using prehospital clinical algorithms did not appear to be useful. In this population of blunt trauma patients, these criteria were not found to be predictive, specific, or sensitive of spinal injury. For patients transported by helicopter, there should not be adoption of prehospital spinal immobilization clearance algorithms using existing criteria.

• Availability:
  • Find a library where document is available. Order URL: http://worldcat.org/issn/00225282
• Authors:
  • Werman, Howard A
  • White, Lynn J
  • Herron, Holly
  • Deppe, Sharon
  • Love, Lisa
  • Betz, Sally
  • Santanello, Steven
• Publication Date: 2008-6

Language

• English

Media Info

• Media Type: Print
• Features: References; Tables;
• Pagination: pp 1539-1542
• Serial:
  • Journal of Trauma, Injury, Infection and Critical Care
  • Volume: 64
  • Issue Number: 6
  • Publisher: Lippincott Williams & Wilkins
  • ISSN: 0022-5282

Subject/Index Terms

• TRT Terms: Algorithms; Injuries; Mathematical prediction
• Uncontrolled Terms: Emergency air medical transport; Immobilization; Pre-hospital care; Spinal cord injury; Stabilization
• Subject Areas: Aviation; Data and Information Technology; Safety and Human Factors;

Filing Info

• Accession Number: 01104103
• Record Type: Publication
• Files: TRIS
• Created Date: Jul 17 2008 9:23AM