Ten Brinke J G, Gebbink W K, Pallada L, Saltzherr T P, Hogervorst M, Goslings J C
Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Department of Surgery, Gelre Hospital Apeldoorn, Apeldoorn, The Netherlands.
Eur J Trauma Emerg Surg. 2018 Aug;44(4):551-554. doi: 10.1007/s00068-017-0828-0. Epub 2017 Aug 5.
Current guidelines state that trauma patients at risk of spine injury should undergo prehospital spine immobilization to reduce the risk of neurological deterioration. Although this approach has been accepted and implemented as a standard for decades, there is little scientific evidence to support it. Furthermore, the potential dangers and sequelae of spine immobilization have been extensively reported. The role of the paramedic in this process has not yet been examined. The aim of this study was to evaluate the accuracy of prehospital evaluations for the presence of spine fractures made by paramedics.
All patients who presented with prehospital spine immobilization at our level II trauma center between January 2013 and January 2014 were prospectively included in a database. Prior to the diagnosis, paramedics recorded the probability of a spine fracture after a prehospital examination. These predictions were compared with patient outcomes. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated.
One hundred and thirty-nine patients were included that positive predictive value was 22%, negative predictive value was 95%, sensitivity was 92%, specificity was 30%, and accuracy was 41%.
The results of this study suggest that paramedics cannot accurately predict spinal fractures.
当前指南指出，有脊柱损伤风险的创伤患者应在院前进行脊柱固定，以降低神经功能恶化的风险。尽管这种方法已被接受并作为标准实施了数十年，但几乎没有科学证据支持这一点。此外，脊柱固定的潜在危险和后遗症已被广泛报道。护理人员在这一过程中的作用尚未得到研究。本研究的目的是评估护理人员对脊柱骨折的院前评估的准确性。
2013年1月至2014年1月期间在我们的二级创伤中心进行院前脊柱固定的所有患者被前瞻性纳入一个数据库。在诊断之前，护理人员记录了院前检查后脊柱骨折的可能性。将这些预测与患者的结果进行比较。计算敏感性、特异性、阳性预测值和阴性预测值。
纳入139例患者，阳性预测值为22%，阴性预测值为95%，敏感性为92%，特异性为30%，准确性为41%。
本研究结果表明，护理人员不能准确预测脊柱骨折。
