Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario Canada; Ottawa Hospital Research Institute, the Ottawa Hospital, Ottawa, Ontario, Canada; Regional Paramedic Program for Eastern Ontario, Ottawa, Ontario, Canada.
Ottawa Hospital Research Institute, the Ottawa Hospital, Ottawa, Ontario, Canada.
Ann Emerg Med. 2023 Feb;81(2):187-196. doi: 10.1016/j.annemergmed.2022.08.441. Epub 2022 Oct 31.
The Canadian C-spine rule was modified and validated for use by the paramedics in a multicenter study where patients were assessed with the Canadian C-spine rule yet all transported with immobilization. This study evaluated the clinical impact of the modified Canadian C-spine rule when implemented by paramedics.
This single-center prospective cohort implementation study took place in Ottawa, Canada (from 2011 to 2015). Advanced and primary care paramedics were trained to use the modified Canadian C-spine rule, collect data on a standardized study form, and selectively transport eligible patients without immobilization. We evaluated all consecutive low-risk adult patients (Glasgow Coma Scale [GCS] 15, stable vital signs) at risk for a neck injury. We followed all patients without initial radiologic evaluation for 30 days. Analyses included descriptive statistics with 95% confidence intervals (CI), sensitivity, specificity, and kappa coefficients.
The 4,034 enrolled patients had a mean age of 43 (range 16 to 99), and 53.4% were female. Motor vehicle collisions were the most common mechanism of injury (55.1%), followed by falls (23.9%). There were 11 clinically important injuries. The paramedics classified these injuries with a sensitivity of 90.9% (95% CI, 58.7 to 99.8) and specificity of 66.5% (95% CI, 65.1 to 68.0). There was no adverse event or resulting spinal cord injury. The kappa agreement between paramedics and investigators was 0.94. A total of 2,583 (64.0%) immobilizations were avoided using the modified Canadian C-spine rule.
Paramedics could accurately apply the modified Canadian C-spine rule to low-risk trauma patients and significantly reduce the need for spinal immobilization during transport. This resulted in no adverse event or any spinal cord injury.
加拿大颈椎规则（Canadian C-spine rule）经修改并在一项多中心研究中得到验证，该研究中患者接受加拿大颈椎规则评估，但所有患者均采用固定方式进行转运。本研究评估了改良后的加拿大颈椎规则由急救人员实施时的临床影响。
这是一项在加拿大渥太华进行的单中心前瞻性队列实施研究（2011 年至 2015 年）。高级和初级护理急救人员接受了使用改良加拿大颈椎规则的培训，使用标准化研究表格收集数据，并选择性地转运符合条件的无需固定的患者。我们评估了所有连续的低风险成年患者（格拉斯哥昏迷量表[GCS] 15 分，生命体征稳定），这些患者有颈部受伤的风险。我们对所有未进行初始影像学评估的患者进行了 30 天的随访。分析包括 95%置信区间（CI）、灵敏度、特异性和 Kappa 系数的描述性统计。
纳入的 4034 名患者平均年龄为 43 岁（16 岁至 99 岁），53.4%为女性。机动车碰撞是最常见的损伤机制（55.1%），其次是跌倒（23.9%）。有 11 例临床重要损伤。急救人员对这些损伤的分类具有 90.9%的敏感性（95%CI，58.7%至 99.8%）和 66.5%的特异性（95%CI，65.1%至 68.0%）。无不良事件或由此导致的脊髓损伤。急救人员和研究人员之间的 Kappa 一致性为 0.94。使用改良的加拿大颈椎规则避免了 2583 例（64.0%）固定。
急救人员可以准确地将改良后的加拿大颈椎规则应用于低风险创伤患者，并显著减少转运过程中对脊柱固定的需求。这没有导致不良事件或任何脊髓损伤。
