Hofstetter Paula, Schröder Hanna, Beckers Stefan K, Borgs Christina, Rossaint Rolf, Felzen Marc
Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany.
Department of Anesthesiology, Rhein-Maas Klinikum, Würselen, Germany.
Open Access Emerg Med. 2023 May 8;15:145-155. doi: 10.2147/OAEM.S386650. eCollection 2023.
The NEXUS-low-risk criteria (NEXUS) and Canadian C-spine rule (CSR) are clinical decision tools used for the prehospital spinal clearance in trauma patients, intending to prevent over- as well as under immobilization. Since 2014, a holistic telemedicine system is part of the emergency medical service (EMS) in Aachen (Germany). This study aims to examine whether the decisions to immobilize or not by EMS- and tele-EMS physicians are based on NEXUS and the CSR, as well as the guideline adherence concerning the choice of immobilization device.
A single-site retrospective chart review was undertaken. Inclusion criteria were EMS physician and tele-EMS physician protocols with traumatic diagnoses. Matched pairs were formed, using age, sex and working diagnoses as matching criteria. The primary outcome parameters were the criteria documented as well as the immobilization device used. The evaluation of the decision to immobilize based on the criteria documented was defined as secondary outcome parameter.
Of a total of 247 patients, 34% (n = 84) were immobilized in the EMS physician group and 32.79% (n = 81) in the tele-EMS physician group. In both groups, less than 7% NEXUS or CSR criteria were documented completely. The decision to immobilize or not was appropriately implemented in 127 (51%) in the EMS-physician and in 135 (54, 66%) in the tele-EMS physician group. Immobilization without indication was performed significantly more often by tele-EMS physicians (6.88% vs 2.02%). A significantly better guideline adherence was found in the tele-EMS physician group, preferring the vacuum mattress (25, 1% vs 8.9%) over the spineboard.
It could be shown that NEXUS and CSR are not applied regularly, and if so, mostly inconsistently with incomplete documentation by both EMS- and tele-EMS physicians. Regarding the choice of the immobilization device a higher guideline adherence was shown among the tele-EMS physicians.
NEXUS低风险标准（NEXUS）和加拿大颈椎规则（CSR）是用于创伤患者院前脊柱评估的临床决策工具，旨在防止过度固定和固定不足。自2014年以来，一个整体远程医疗系统成为德国亚琛紧急医疗服务（EMS）的一部分。本研究旨在探讨EMS医生和远程EMS医生决定是否进行固定是否基于NEXUS和CSR，以及关于固定设备选择的指南遵循情况。
进行了一项单中心回顾性病历审查。纳入标准为有创伤诊断的EMS医生和远程EMS医生的诊疗记录。以年龄、性别和工作诊断为匹配标准形成匹配对。主要结局参数是记录的标准以及使用的固定设备。基于记录的标准对固定决定的评估被定义为次要结局参数。
在总共247例患者中，EMS医生组34%（n = 84）进行了固定，远程EMS医生组32.79%（n = 81）进行了固定。在两组中，完全记录NEXUS或CSR标准的均不到7%。EMS医生组127例（51%）、远程EMS医生组135例（54.66%）的固定或不固定决定得到了适当执行。远程EMS医生进行无指征固定的情况明显更多（6.88%对2.02%）。在远程EMS医生组中发现对指南的遵循情况明显更好，他们更倾向于使用真空床垫（25.1%对8.9%）而非脊柱板。
可以看出，NEXUS和CSR未得到常规应用，即便应用，EMS医生和远程EMS医生大多记录不完整且不一致。关于固定设备的选择，远程EMS医生对指南的遵循情况更高。
