Clemency Brian M, Tanski Christopher T, Gibson Chambers Jennifer, O'Brien Michael, Knapp Andrew S, Clark Alexander J, McGoff Patrick, Innes Johanna, Lindstrom Heather A, Hostler David
Prehosp Emerg Care. 2018 Jul-Aug;22(4):506-510. doi: 10.1080/10903127.2017.1413465. Epub 2018 Feb 15.
Backboards have been shown to cause pain in uninjured patients. This may alter physical exam findings, leading emergency department (ED) providers to suspect a spinal injury when none exists resulting in additional imaging of the thoracolumbar spine. New York had previously employed a "Spinal Immobilization" protocol that included compulsory backboard application for all patients with suspected spinal injuries. In 2015, New York instituted a new "Spinal Motion Restriction" protocol that made backboard use optional for these patients. The objective of this study was to determine if this protocol change was associated with decreased backboard utilization and ED thoracolumbar spine imaging.
This was a retrospective before-and-after chart review of subjects transported by a single emergency medical services (EMS) agency to one of four EDs for emergency calls dispatched as motor vehicle collisions (MVC). EMS and ED data were included for all calls within a 6-month interval before and after the protocol change. The protocol change was implemented in the second half of 2015. Subject demographics, backboard use, and spine imaging were reviewed for the intervals January-June 2015 and January-June 2016.
There were 818 subjects in the before period and 796 subjects in the after period. Subjects were similar in terms of gender, age and type of MVC in both periods. A backboard was utilized for 440 (54%) subjects in the before period and 92 (12%) subjects in the after period (p < 0.001). ED thoracic spine imaging was performed on 285 (35%) subjects in the before period, and 235 (30%) subjects in the after period (p = 0.02). ED lumbar spine imaging was performed for 335 (41%) subjects in the before period, and 281 (35%) subjects in the after period (p = 0.02).
A shift from a spinal immobilization protocol to a spinal motion restriction protocol was associated with a decrease in backboard utilization by EMS providers and a decrease in thoracolumbar spine imaging by ED providers.
已证实脊柱固定板会给未受伤的患者带来疼痛。这可能会改变体格检查结果，导致急诊科（ED）医护人员在不存在脊柱损伤的情况下怀疑有脊柱损伤，从而对胸腰椎进行额外的影像学检查。纽约州此前采用了一项“脊柱固定”方案，该方案要求对所有疑似脊柱损伤的患者强制使用脊柱固定板。2015年，纽约州制定了一项新的“脊柱活动限制”方案，该方案规定这些患者可选择使用脊柱固定板。本研究的目的是确定这一方案的改变是否与脊柱固定板使用率的降低以及急诊科胸腰椎影像学检查的减少有关。
这是一项回顾性前后图表审查研究，研究对象为由单一紧急医疗服务（EMS）机构转运至四家急诊科之一的因机动车碰撞（MVC）而发出紧急呼叫的患者。方案改变前后6个月内的所有呼叫均纳入了EMS和ED数据。方案改变于2015年下半年实施。对2015年1月至6月和2016年1月至6月期间的研究对象人口统计学特征、脊柱固定板使用情况和脊柱影像学检查进行了审查。
方案改变前有818名研究对象，方案改变后有796名研究对象。两个时期的研究对象在性别、年龄和MVC类型方面相似。方案改变前，440名（54%）研究对象使用了脊柱固定板，方案改变后，92名（12%）研究对象使用了脊柱固定板（p<0.001）。方案改变前，285名（35%）研究对象接受了急诊科胸椎影像学检查，方案改变后，235名（30%）研究对象接受了该项检查（p=0.02）。方案改变前，335名（41%）研究对象接受了急诊科腰椎影像学检查，方案改变后，281名（35%）研究对象接受了该项检查（p=0.02）。
从脊柱固定方案转变为脊柱活动限制方案与EMS医护人员脊柱固定板使用率的降低以及ED医护人员胸腰椎影像学检查的减少有关。
