Prehosp Emerg Care. 2020 May-Jun;24(3):401-410. doi: 10.1080/10903127.2019.1645923. Epub 2019 Aug 14.
Many emergency medical services (EMS) agencies have de-emphasized or eliminated the use of long spinal boards (LSB) for patients with possible spinal injury. We sought to determine if implementation of spinal motion restriction (SMR) protocols, which reduce LSB use, was associated with an increase in spinal cord injury (SCI). This retrospective observational study includes EMS encounters from January 1, 2013 to December 31, 2015 submitted by SMR-adopting ground-based agencies to a state EMS database with hospital discharge data. Encounters were excluded if SMR implementation date was unknown, occurred during a 3-month run-in period, or were duplicates. Study samples include patients with traumatic injury (TI), possible spinal trauma (P-ST), and verified spinal trauma (V-ST) using hospital discharge ICD-9/10 diagnosis codes. The incidence of SCI before and after implementation of SMR was compared using Chi-squared and logistic regression. From 1,005,978 linked encounters, 104,315 unique encounters with traumatic injury and known SMR implementation date were identified with 51,199 cases of P-ST and 5,178 V-ST cases. The incidence of SCI in the pre-SMR and post-SMR interval for each group was: TI, 0.20% vs. 0.22% (p = 0.390); P-ST, 0.40% vs. 0.45% (p = 0.436); and V-ST, 4.04% vs. 4.37% (p = 0.561). Age and injury severity adjusted odds ratio of SCI in the highest risk cohort of patients with V-ST was 1.097 after SMR implementation (95% CI 0.818-1.472). In this limited study, no change in the incidence of SCI was identified following implementation of SMR protocols. Prospective evaluation of this question is necessary to evaluate the safety of SMR protocols.
许多急救医疗服务（EMS）机构已经减少或不再使用长脊柱板（LSB）来治疗可能有脊柱损伤的患者。我们旨在确定是否实施脊柱运动限制（SMR）方案会导致脊髓损伤（SCI）的发生率增加，因为这些方案减少了 LSB 的使用。本回顾性观察性研究包括 2013 年 1 月 1 日至 2015 年 12 月 31 日期间，采用 SMR 的地面基础机构向州 EMS 数据库提交的与医院出院数据相关的 EMS 接触情况。如果 SMR 实施日期未知、发生在 3 个月的试用期内或为重复数据，则将接触情况排除在外。研究样本包括使用医院出院 ICD-9/10 诊断代码诊断为创伤性损伤（TI）、可能的脊柱创伤（P-ST）和已确认的脊柱创伤（V-ST）的患者。使用卡方检验和逻辑回归比较 SMR 实施前后 SCI 的发生率。从 1005978 次相关接触中，确定了 104315 次具有创伤性损伤和已知 SMR 实施日期的独特接触情况，其中 51199 例为 P-ST，5178 例为 V-ST。在每个组的 SMR 实施前和实施后的 SCI 发生率分别为：TI 为 0.20%比 0.22%（p=0.390）；P-ST 为 0.40%比 0.45%（p=0.436）；V-ST 为 4.04%比 4.37%（p=0.561）。SMR 实施后，V-ST 患者中最高风险组的 SCI 年龄和损伤严重程度调整比值比为 1.097（95%CI 0.818-1.472）。在这项有限的研究中，未发现 SMR 方案实施后 SCI 发生率发生变化。有必要进行前瞻性评估来评估 SMR 方案的安全性。
