Miller Phil, Coffey Frank, Reid Anne-Marie, Stevenson Keith
University Hospital Nottingham, Derby Road, Nottingham NG7 2UH, United Kingdom.
Accid Emerg Nurs. 2006 Jul;14(3):133-40. doi: 10.1016/j.aaen.2006.03.003. Epub 2006 May 30.
The Canadian c-spine rule (CCR) allows safe, reproducible use of radiography in alert, stable patients with potential c-spine injury in the emergency setting [Stiell, I., Clement, C., McKnight, R., Brison, R., Schull, M., Lowe, B., Worthington, J., Eisenhauer, M., Cass, D., Greenberg, G., MacPhail, I., Dreyer, J., Lee, J., Bandiera, G., Reardon, M., Holroyd, B., Lesiuk, H., G. Wells, 2003. The Canadian c-spine rule versus the nexus low-risk criteria in patients with trauma. The New England journal of medicine 349 (26), 2510-2518; Stiell, I., Wells, G., Vandemheen, K., Clement, C., 2001. The Canadian c-spine rule for radiography in alert and stable trauma patients. JAMA 286 (15), 1841]. This paper reports on a study of emergency nurses' ability to identify patients requiring immobilisation using the CCR. Emergency department triage nurses (N = 112) were trained in the use of the CCR and then asked to use the tool over the following 14 months in the assessment of 460 patients who presented with potential c-spine injury. Trained medical staff repeated 55% of the clinical assessments independently using the rule. The level of agreement between nurse and medical judgement was calculated. The inter-rater reliability using the kappa statistic was 0.6 (95% CI 0.50-0.62 N = 254) indicating a 'good' level of agreement. The majority of nurses indicated they were comfortable using the rule. The results suggest that UK emergency department nurses were able to use the Canadian c-spine rule to successfully guide selective immobilisation. A 25% reduction in immobilisation rates would have been achieved if the rule had been followed. Further studies are needed to test the reduction in levels of immobilisation that could be achieved in clinical practice.
加拿大颈椎规则（CCR）允许在急诊环境中对警觉、稳定且可能存在颈椎损伤的患者安全、可重复地使用X光检查[斯蒂尔，I.，克莱门特，C.，麦克奈特，R.，布里森，R.，舒尔，M.，洛威，B.，沃辛顿，J.，艾森豪尔，M.，卡斯，D.，格林伯格，G.，麦克菲尔，I.，德雷尔，J.，李，J.，班迪耶拉，G.，里尔登，M.，霍洛伊德，B.，莱西克，H.，G.韦尔斯，2003年。加拿大颈椎规则与创伤患者的Nexus低风险标准比较。《新英格兰医学杂志》349（26），2510 - 2518；斯蒂尔，I.，韦尔斯，G.，万德姆赫恩，K.，克莱门特，C.，2001年。用于警觉和稳定创伤患者X光检查的加拿大颈椎规则。《美国医学会杂志》286（15），1841]。本文报告了一项关于急诊护士使用CCR识别需要固定的患者的能力的研究。急诊科分诊护士（N = 112）接受了CCR使用培训，然后在接下来的14个月里被要求使用该工具评估460名可能存在颈椎损伤的患者。经过培训的医务人员独立使用该规则重复了55%的临床评估。计算了护士和医生判断之间的一致程度。使用kappa统计量的评分者间信度为0.6（95%可信区间0.50 - 0.62，N = 254），表明一致程度“良好”。大多数护士表示他们对使用该规则感到满意。结果表明，英国急诊科护士能够使用加拿大颈椎规则成功指导选择性固定。如果遵循该规则，固定率将降低25%。需要进一步研究以测试在临床实践中可实现的固定水平降低情况。
