Prehospital Center Region Zealand, Ringstedgade 61, 13, 4700, Næstved, Denmark.
Department of Neonatal and Pediatric Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Scand J Trauma Resusc Emerg Med. 2024 Aug 23;32(1):76. doi: 10.1186/s13049-024-01249-3.
Trauma guidelines on spinal motion restriction (SMR) have changed drastically in recent years. An international group of experts explored whether consensus could be reached and if guidelines on SMR performed by trained lifeguards and prehospital EMS following in-water traumatic spinal cord injury (TSCI) should also be changed.
An international three-round Delphi process was conducted from October 2022 to November 2023. In Delphi round one, brainstorming resulted in an exhaustive list of recommendations for handling patients with suspected in-water TSCI. The list was also used to construct a preliminary flowchart for in-water SMR. In Delphi round two, three levels of agreement for each recommendation and the flowchart were established. Recommendations with strong consensus (≥ 85% agreement) underwent minor revisions and entered round three; recommendations with moderate consensus (75-85% agreement) underwent major revisions in two consecutive phases; and recommendations with weak consensus (< 75% agreement) were excluded. In Delphi round 3, the level of consensus for each of the final recommendations and each of the routes in the flowchart was tested using the same procedure as in Delphi round 2.
Twenty-four experts participated in Delphi round one. The response rates for Delphi rounds two and three were 92% and 88%, respectively. The study resulted in 25 recommendations and one flowchart with four flowchart paths; 24 recommendations received strong consensus (≥ 85%), and one recommendation received moderate consensus (81%). Each of the four paths in the flowchart received strong consensus (90-95%). The integral flowchart received strong consensus (93%).
This study produced expert consensus on 25 recommendations and a flowchart on handling patients with suspected in-water TSCI by trained lifeguards and prehospital EMS. These results provide clear and simple guidelines on SMR, which can standardise training and guidelines on SMR performed by trained lifeguards or prehospital EMS.
近年来，创伤性脊柱运动限制（SMR）指南发生了巨大变化。一组国际专家探讨了是否能够达成共识，以及对于经过培训的救生员和院前 EMS 在水中创伤性脊髓损伤（TSCI）后进行的 SMR 指南是否也应进行更改。
从 2022 年 10 月至 2023 年 11 月，进行了三轮国际 Delphi 流程。在 Delphi 第一轮中，头脑风暴产生了一份详尽的建议清单，用于处理疑似水中 TSCI 的患者。该清单还用于构建水中 SMR 的初步流程图。在 Delphi 第二轮中，为每个建议和流程图建立了三个级别的一致性。具有强烈共识（≥85%的一致性）的建议进行了小修订并进入第三轮；具有中度共识（75-85%的一致性）的建议进行了两轮连续修订；具有弱共识（<75%的一致性）的建议被排除。在 Delphi 第 3 轮中，使用与 Delphi 第 2 轮相同的程序测试最终建议和流程图中每条路线的一致性水平。
24 名专家参加了 Delphi 第一轮。第二轮和第三轮的回复率分别为 92%和 88%。该研究产生了 25 项建议和一张流程图，其中包含四条流程图路径；24 项建议获得强烈共识（≥85%），一项建议获得中度共识（81%）。流程图中的四条路径均获得强烈共识（90-95%）。整体流程图获得强烈共识（93%）。
本研究就经过培训的救生员和院前 EMS 处理疑似水中 TSCI 患者的 25 项建议和流程图达成了专家共识。这些结果提供了关于 SMR 的清晰简单的指南，可以规范经过培训的救生员或院前 EMS 进行的 SMR 培训和指南。
