Value of prehospital assessment of spine fracture by paramedics

Abstract

BackgroundCurrent guidelines state that trauma patients at risk of spine injury should undergo prehospital spine immobilization to reduce the risk of neurological deterioration. Although this approach has been accepted and implemented as a standard for decades, there is little scientific evidence to support it. Furthermore, the potential dangers and sequelae of spine immobilization have been extensively reported. The role of the paramedic in this process has not yet been examined. The aim of this study was to evaluate the accuracy of prehospital evaluations for the presence of spine fractures made by paramedics.MethodsAll patients who presented with prehospital spine immobilization at our level II trauma center between January 2013 and January 2014 were prospectively included in a database. Prior to the diagnosis, paramedics recorded the probability of a spine fracture after a prehospital examination. These predictions were compared with patient outcomes. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated.ResultsOne hundred and thirty-nine patients were included that positive predictive value was 22%, negative predictive value was 95%, sensitivity was 92%, specificity was 30%, and accuracy was 41%.ConclusionsThe results of this study suggest that paramedics cannot accurately predict spinal fractures.

Diagnostic accuracy of clinical examination to identify life- and limb-threatening injuries in trauma patients

“…Accurate initial clinical assessment of trauma patients for LLTIs is a known challenge, especially for internal injuries of torso and major vascular injuries [11,19,[40][41][42][43][44][45][46][47][48]. Studies have reported a wide range of sensitivity of clinical examination per body region: head (58-93%) [40,42], thoracic (45-60%) [40,42], abdominal (39-59%) [40,42,43], pelvic (45-86%) [19,42,44,45], spinal (60-92%) [42,[46][47][48], and extremity injuries (33-91%) [42]. Similarly, the PPV of clinical examination varied according to body region: head (91%) [41], thorax (70-90%) [11,41], abdomen (43-70%) [41,43] pelvis (69%) [41], spine (62%) [41], and extremity injuries (91%) [41].…”

Self-extrication and selective spinal immobilisation in a polytrauma patient with spinal injuries

“…The ability of pre-hospital practitioners to accurately predict the presence of bony spinal injuries is inconsistent, 9 so a high index of suspicion based upon mechanism of injury/co-morbidity/age should be maintained over decisions regarding immobilisation/triage.…”