Burton John H, Dunn Matthew G, Harmon Nathan R, Hermanson Tari A, Bradshaw Jay R
Department of Emergency Medicine, Albany Medical College, Albany, New York 12208-3479, USA.
J Trauma. 2006 Jul;61(1):161-7. doi: 10.1097/01.ta.0000224214.72945.c4.
To evaluate the practices and outcomes associated with a statewide, emergency medical services (EMS) protocol for trauma patient spine assessment and selective patient immobilization.
An EMS spine assessment protocol was instituted on July 1, 2002 for all EMS providers in the state of Maine. Spine immobilization decisions were prospectively collected with EMS encounter data. Prehospital patient data were linked to a statewide hospital database that included all patients treated for spine fracture during the 12-month period following the spine assessment protocol implementation. Incidence of spine fractures among EMS-assessed trauma patients and the correlation between EMS spine immobilization decisions and the presence of spine fractures-stable and unstable-were the primary investigational outcomes.
There were 207,545 EMS encounters during the study period, including 31,885 transports to an emergency department for acute trauma-related illness. For this cohort, there were 12,988 (41%) patients transported with EMS spine immobilization. Linkage of EMS and hospital data revealed 154 acute spine fracture patients; 20 (13.0%) transported without EMS-reported spine immobilization interventions. This nonimmobilized group included 19 stable spine fractures and one unstable thoracic spine injury. The protocol sensitivity for immobilization of any acute spine fracture was 87.0% (95% confidence interval [CI], 81.7-92.3) with a negative predictive value of 99.9% (95% CI, 99.8-100).
The use of this statewide EMS spine assessment protocol resulted in one nonimmobilized, unstable spine fracture patient in approximately 32,000 trauma encounters. Presence of the protocol affected a decision not to immobilize greater than half of all EMS-assessed trauma patients.
评估一项全州范围的紧急医疗服务（EMS）创伤患者脊柱评估及选择性患者固定方案的实施情况和结果。
2002年7月1日，缅因州所有紧急医疗服务提供者开始实施一项EMS脊柱评估方案。脊柱固定决策与紧急医疗服务遭遇数据一起前瞻性收集。院前患者数据与全州范围的医院数据库相链接，该数据库包含在脊柱评估方案实施后的12个月内所有接受脊柱骨折治疗的患者。紧急医疗服务评估的创伤患者中脊柱骨折的发生率以及紧急医疗服务脊柱固定决策与脊柱骨折（稳定和不稳定）存在之间的相关性是主要研究结果。
研究期间有207,545次紧急医疗服务遭遇，包括31,885次因急性创伤相关疾病转运至急诊科。对于该队列，有12,988名（41%）患者在紧急医疗服务时进行了脊柱固定转运。紧急医疗服务和医院数据的链接显示有154名急性脊柱骨折患者；20名（13.0%）在紧急医疗服务报告中未进行脊柱固定干预。这个未固定组包括19例稳定脊柱骨折和1例不稳定胸椎损伤。任何急性脊柱骨折固定的方案敏感性为87.0%（95%置信区间[CI]，81.7 - 92.3），阴性预测值为99.9%（95%CI，99.8 - 100）。
使用该全州范围的紧急医疗服务脊柱评估方案，在大约32,000次创伤遭遇中会出现1例未固定的不稳定脊柱骨折患者。该方案的存在影响了超过一半的所有紧急医疗服务评估的创伤患者不进行固定的决策。
