The L&S is preferable to the LR when possible for minimizing unwanted C-spine motion. There is little overall difference between HS and TS in a cooperative patient. When a patient is confused, the HS is much worse than the TS at minimizing C-spine motion.
BackgroundProper stabilisation of suspected unstable spine injuries is necessary to prevent (worsen) spinal cord damage. Although the lift-and-slide (L&S) technique has been shown superior to the log-roll (LR) technique to place the body on the spinal board, no studies have yet compared different techniques of manual stabilisation of the c-spine itself.ObjectiveTo compare cervical motions that occur when trained professionals perform the Head Squeeze (HS) and Trap Squeeze (TS) c-spine stabilisation techniques.DesignCross-over.Setting and participants12 experienced therapists.AssessmentHS and TS during lift-and-slide (L&S) and LR placement on spinal board, and agitated patient trying to trying to sit up (AGIT-Sit) or rotate his head (AGIT-Rot).Main outcome measurementsPeak head motion with respect to initial conditions using inertial measurement units attached to the forehead and trunk of the simulated patient. Comparisons between HS and TS with a priori minimal important difference (MID) of 5° for flexion or extension, and 3° for rotation or lateral flexion.ResultsOverall, the L&S technique was statistically superior to the LR technique. The only differences to exceed the MID were extension and rotation during LR (HS>TS). In the AGIT-Sit test scenario, differences in motion exceeded MID (HS>TS) for flexion, rotation and lateral flexion. In the AGIT-Rot scenario, differences in motion exceeded MID for rotation only (HS>TS). There was similar inter-trial variability of motion for HS and TS during L&S and LR, but significantly more variability with HS compared to TS in the agitated patient.ConclusionThe L&S is preferable to the LR when possible for minimizing unwanted c-spine motion. There is little overall difference between HS and TS in a cooperative patient. When a patient is confused and trying to move, the HS is much worse than the TS at minimizing c-spine motion.
Background Proper stabilisation of suspected unstable spine injuries is necessary to prevent (worsen) spinal cord damage. Almost all training relies on subjective reports from the simulated patient or observations from an independent person. The reliability and validity of these measures remains unknown. Objective To determine 1) how accurately rescuers and simulated patients assess motion during cervical spine (c-spine) stabilisation practice, and 2) if providing feedback on performance infl uences behaviour preferences. Design Cross-over design. Setting and Participants 12 experienced therapists. Assessment Head Squeeze and Trap Squeeze (random order) c-spine stabilisation during four test scenarios: lift-and-slide (L&S) and log-roll (LR) placement on spinal board, and agitated patient trying to sit up (AGIT-SIT) or rotate head (AGIT-ROT). Main outcome measurements Inter-rater reliability between rescuer and simulated patient quality scores for subjective evaluation of c-spine stabilisation during trials (0=best, 10=worst), correlation between rescuers' quality score and objective measure of motion with inertial measurement units (IMU), and frequency of change in preference for Head Squeeze vs Trap Squeeze. Results Although the weighted-kappa for inter-rater reliability was acceptable (0.71-0.74), scores varied by more than one points between rescuers/simulated patients for ~10-15% of trials. Rescuers' scores correlated with objective measures but with large variability. For example, 38% of trials scored as almost perfect (0-1) by the rescuer actually had >10° of motion in at least one direction. In general, feedback did not affect preference for L&S. For the LR, 6/8 subjects preferring Head Squeeze at baseline preferred Trap Squeeze after feedback. For the confused patient, 5/5 subjects preferring Head Squeeze at baseline preferred Trap Squeeze after feedback.
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