Can a rescuer or simulated patient accurately assess motion during cervical spine stabilisation practice sessions?

Abstract

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.