Meldon S W, Brant T A, Cydulka R K, Collins T E, Shade B R
Department of Surgery, Case Western Reserve University, Cleveland, Ohio, USA.
J Trauma. 1998 Dec;45(6):1058-61. doi: 10.1097/00005373-199812000-00014.
Determine the level of agreement between emergency medical technicians (EMTs) and emergency physicians (EPs) when applying an existing emergency medical services/fire department protocol for out-of-hospital clinical cervical spine injury (CSI) clearance in blunt trauma patients.
Prospective observational study of consecutive blunt trauma patients transported by emergency medical services/fire department during a 3-month study period. The setting was an urban Level I trauma center. Measurement of interrater agreement (kappa) was determined.
Mean age of the 190 patients was 34+/-19 years (range, 6 -98 years). Fifty-nine percent of the patients were male. One hundred forty-six patients (77%) were immobilized by EMTs; 17 of these patients were clinically cleared by EPs. Forty-four patients (23%) were clinically cleared by EMTs and presented without CSI precautions; of these, 61% (27 of 44) were immobilized by EPs and 57% (25 of 44) had cervical spine radiographs obtained. Overall, 141 patients (74%) required radiographic clearance. CSI were detected in five patients (2.6%); all five were immobilized in the out-of-hospital setting. Overall disagreement between EMTs and EPs regarding out-of-hospital CSI clearance occurred in 44 patients (23%) (kappa=0.29; 95% confidence interval, 0.15-0.43; p < 0.01).
Significant disagreement in clinical CSI clearance exists between EMTs and EPs. Further research and education is recommended before widespread implementation of this practice.
在对钝性创伤患者应用现有的院外临床颈椎损伤（CSI）清除的紧急医疗服务/消防部门协议时，确定急救医疗技术人员（EMT）与急诊医师（EP）之间的一致性水平。
对在3个月研究期间由紧急医疗服务/消防部门转运的连续钝性创伤患者进行前瞻性观察研究。研究地点为城市一级创伤中心。确定评估者间一致性（kappa）的测量值。
190例患者的平均年龄为34±19岁（范围6 - 98岁）。59%的患者为男性。146例患者（77%）被EMT固定；其中17例患者被EP临床清除。44例患者（23%）被EMT临床清除且就诊时未采取CSI预防措施；其中，61%（44例中的27例）被EP固定，57%（44例中的25例）进行了颈椎X线检查。总体而言，141例患者（74%）需要影像学清除。5例患者（2.6%）检测到CSI；所有5例在院外均被固定。EMT与EP在院外CSI清除方面的总体分歧发生在44例患者（23%）中（kappa = 0.29；95%置信区间，0.15 - 0.43；p < 0.01）。
EMT与EP在临床CSI清除方面存在显著分歧。在广泛实施这种做法之前，建议进行进一步的研究和教育。
