Evaluation of the safety of C-spine clearance by paramedics: Design and methodology

BMC Emergency Medicine

Volumn 11, Issue , 2011, Pages

  Vaillancourt, Christian ^a,b,c   Charette, Manya ^a   Kasaboski, Ann ^a   Maloney, Justin ^b,c   Wells, George A ^a,b   Stiell, Ian G ^a,b  

^a OTTAWA HOSPITAL RESEARCH INSTITUTE   (Canada)

^b UNIVERSITY OF OTTAWA   (Canada)

^c Eastern Ontario Regional Genetics Program   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; ARTICLE; CANADA; CERVICAL SPINE INJURY; CLEARANCE; CLINICAL DECISION MAKING; COHORT ANALYSIS; CONTROLLED STUDY; EMERGENCY HEALTH SERVICE; EMERGENCY WARD; HUMAN; IMMOBILIZATION; METHODOLOGY; OUTCOME ASSESSMENT; PARAMEDICAL PERSONNEL; PATIENT SAFETY; PATIENT TRANSPORT; PERFORMANCE; PROSPECTIVE STUDY; VALIDATION STUDY; CLINICAL TRIAL; DECISION SUPPORT SYSTEM; EDUCATION; SAFETY; STANDARD;

ADULT; ALLIED HEALTH PERSONNEL; CANADA; COHORT STUDIES; DECISION SUPPORT TECHNIQUES; HUMANS; IMMOBILIZATION; PROSPECTIVE STUDIES; RESEARCH DESIGN; SAFETY; TRANSPORTATION OF PATIENTS;

EID: 79351470285     PISSN: None     EISSN: 1471227X     Source Type: Journal    
DOI: 10.1186/1471-227X-11-1     Document Type: Article

References (80)

1. McCaig LF, Burt CW. National Hospital Ambulatory Medical Care Survey: 2000 Emergency Department Summary. Advance Data from Vital and Health Statistics 2004, 340.
2. Reid DC, Henderson R, Saboe L, Miller JDR. Etiology and clinical course of missed spine fractures. J Trauma 1987, 27:980-986. 10.1097/00005373-198709000-00005, 3656481.
3. Diliberti T, Lindsey RW. Evaluation of the cervical spine in the emergency setting: who does not need an x-ray?. Orthopedics - pcm 1992, 15:179-183.
4. Bachulis BL, Long WB, Hynes GD, Johnson MC. Clinical indications for cervical spine radiographs in the traumatized patient. Am J Surg 1987, 153:473-477. 10.1016/0002-9610(87)90796-3, 3578669.
5. Stiell IG, Clement C, McKnight RD, Brison R, Schull MJ, Rowe BH, Worthington JR, Eisenhauer MA, Cass D, Greenberg GH, MacPhail I, Dreyer J, Lee JS, Bandiera G, Reardon M, Holroyd B, Lesiuk H, Wells GA. The Canadian C-spine Rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med 2003, 349:2510-2518. 10.1056/NEJMoa031375, 14695411.
6. McKee TR, Tinkoff G, Rhodes M. Asymptomatic occult cervical spine fracture: case report and review of the literature. J Trauma 1990, 30:623-626. 10.1097/00005373-199005000-00018, 2188001.
7. American College of Surgeons Advanced Trauma Life Support Student Course Manual. 2004, 391. Chicago: American College of Surgeons, 7, American College of Surgeons.
8. Davis JW, Phreaner DL, Hoyt DB, Mackersie RC. The etiology of missed cervical spine injuries. J Trauma 1993, 34:342-346. 10.1097/00005373-199303000-00006, 8483172.
9. Changaris DG. Cervical spine films, cost, and algorithms. Am J Surg 1987, 153:478-478.
10. Woodring JH, Lee C. Limitations of cervical radiography in the evaluation of acute cervical trauma. J Trauma 1993, 34:32-39. 10.1097/00005373-199301000-00006, 8437193.
11. Roberge RJ, Wears RC, Kelly M, Evans TC, Kenny MA, Daffner RD, Kremen R, Murray K, Cottington EC. Selective application of cervical spine radiography in alert victims of blunt trauma: a prospective study. J Trauma 1988, 28:784-788. 10.1097/00005373-198806000-00010, 3385821.
12. Jacobs LM, Schwartz R. Prospective analysis of acute cervical spine injury: a methodology to predict injury. Ann Emerg Med 1986, 15:44-49. 10.1016/S0196-0644(86)80485-1, 3942356.
13. Mirvis SE, Diaconis JN, Chirico PA, Reiner BI, Joslyn JN, Militello P. Protocol-driven radiologic evaluation of suspected cervical spine injury: efficacy study. Radiology 1989, 170:831-834.
14. Stiell IG, Wells GA, Vandemheen K, Laupacis A, Brison R, Eisenhauer MA, Greenberg GH, MacPhail I, McKnight RD, Reardon M, Verbeek R, Worthington J, Lesiuk H. Variation in emergency department use of cervical spine radiography for alert, stable trauma patients. CMAJ 1997, 156:1537-1544. 1227493, 9176419.
15. Vandemark RM. Radiology of the cervical spine in trauma patients: practice pitfalls and recommendations for improving efficiency and communication. AJR 1990, 155:465-472.
16. Fischer RP. Cervical radiographic evaluation of alert patients following blunt trauma. Ann Emerg Med 1984, 13:905-907. 10.1016/S0196-0644(84)80667-8, 6476515.
17. Gbaanador GBM, Fruin AH, Taylon C. Role of routine emergency cervical radiography in head trauma. Am J Surg 1986, 152:643-648. 10.1016/0002-9610(86)90441-1, 3789288.
18. Bayless P, Ray VG. Incidence of cervical spine injuries in association with blunt head trauma. Am J Emerg Med 1989, 7:139-142. 10.1016/0735-6757(89)90125-3, 2920074.
19. Neifeld GL, Keene JG, Hevesy G, Leikin J, Proust A, Thisted RA. Cervical injury in head trauma. J Emerg Med 1988, 6:203-207. 10.1016/0736-4679(88)90327-7, 3049775.
20. Roberge RJ. Facilitating cervical spine radiography in blunt trauma. Emerg Med Clin NA 1991, 9:733-742.
21. Daffner RH. Cervical radiography in the emergency department: who, when, how extensive?. J Emerg Med 1993, 11:619-620. 10.1016/0736-4679(93)90318-2, 8308242.
22. McNamara RM, Heine E, Esposito B. Cervical spine injury and radiography in alert, high-risk patients. J Emerg Med 1990, 8:177-182. 10.1016/0736-4679(90)90229-O, 2362120.
23. Cadoux CG, White JD, Hedberg MC. High-yield roentgenographic criteria for cervical spine injuries. Ann Emerg Med 1987, 16:738-742. 10.1016/S0196-0644(87)80565-6, 3592327.
24. McNamara RM, O'Brien MC, Davidheiser S. Post-traumatic neck pain: a prospective and follow-up study. Ann Emerg Med 1988, 17:906-911. 10.1016/S0196-0644(88)80669-3, 3046446.
25. Kreipke DL, Gillespie KR, McCarthy MC, Mail JT, Lappas JC, Broadie TA. Reliability of indications for cervical spine films in trauma patients. J Trauma 1989, 29:1438-1439. 10.1097/00005373-198910000-00024, 2509727.
26. Hoffman JR, Schriger DL, Mower W, Luo JS, Zucker M. Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med 1992, 21:1454-1460. 10.1016/S0196-0644(05)80059-9, 1443841.
27. Lindsey RW, Diliberti TC, Doherty BJ, Watson AB. Efficacy of radiographic evaluation of the cervical spine in emergency situations. South Med J 1993, 86:1253-1255.
28. Hills MW, Deane SA. Head injury and facial injury: is there an increased risk of cervical spine injury?. J Trauma 1993, 34:549-554. 10.1097/00005373-199304000-00011, 8487340.
29. Ringenberg BJ, Fisher AK, Urdaneta LF, Midthun MA. Rational ordering of cervical spine radiographs following trauma. Ann Emerg Med 1988, 17:792-796. 10.1016/S0196-0644(88)80555-9, 3394981.
30. Saddison D, Vanek VW, Racanelli JL. Clinical indications for cervical spine radiographs in alert trauma patients. Am Surg 1991, 57:366-369.
31. Roberge RJ, Wears RC. Evaluation of neck discomfort, neck tenderness, and neurologic deficits as indicators for radiography in blunt trauma victims. J Emerg Med 1992, 10:539-544. 10.1016/0736-4679(92)90133-E, 1401852.
32. Roberge RJ. Cervical spine radiography after blunt trauma: is it always needed?. Postgrad Med J 1993, 93:205-212.
33. Rosen P, Barkin RM, Danzl DF, Hockberger RS, Ling LJ, Markovchick V, Marx JA, Newton E, Walls RM, Rosen P, Barkin RM, Danzl DF, Hockberger RS, Ling LJ, Markovchick V, Marx JA, Newton E, Walls RM. Emergency medicine: concepts and clinical practice. 1998, Toronto: C.V. Mosby Co.
34. Tintinalli JE, Kelen GD, Stapczynski JS, Tintinalli JE, Kelen GD, Stapczynski JS. Emergency medicine: a comprehensive study guide. 2000, Toronto: McGraw-Hill, Inc.
35. Roth BJ, Martin RR, Foley K, Barcia PJ, Kennedy P. Roentgenographic evaluation of the cervical spine: a selective approach. Arch Surg 1994, 129:643-645.
36. Domeier RM, Swor RA, Evans RW, Hancock JB, Fales W, Krohmer J, Frederiksen SM, Rivera-Rivera EJ, Schork MA. Multicenter prospective validation of prehospital clinical spinal clearance criteria. J Trauma 2002, 53:744-750. 10.1097/00005373-200210000-00021, 12394877.
37. Abrams HL. The "overutilization" of x-rays. N Engl J Med 1979, 300:1213-1216. 10.1056/NEJM197905243002110, 431650.
38. Bauer SJ, Kowalski R. Effect of spinal immobilization devices on pulmonary function in the healthy, nonsmoking man. Ann Emerg Med 1988, 17:915-918. 10.1016/S0196-0644(88)80671-1, 3415063.
39. Chan D, Goldberg R, Tascone A, Harmon S, Chan L. The effect of spinal immobilization on healthy volunteers. Ann Emerg Med 1994, 23:48-51. 10.1016/S0196-0644(94)70007-9, 8273958.
40. Cordell WH, Hollingsworth JC, Olinger ML, Stroman SJ, Nelson DR. Pain and tissue-interface pressures during spine-board immobilization. Ann Emerg Med 1995, 26:31-36. 10.1016/S0196-0644(95)70234-2, 7793717.
41. March JA, Ausband SC, Brown LH. Changes in physical examination caused by use of spinal immobilization. Prehosp Emerg Care 2002, 6:421-424. 10.1080/10903120290938067, 12385610.
42. Schull MJ, Slaughter PM, Redelmeier DA. Urban emergency department overcrowding: defining the problem and eliminating misconceptions. Can J Emerg Med 2002, 4:76-83.
43. Chan BT, Schull MJ, Schultz SE. Emergency department services in Ontario 1993-2000. Institute for Clinical Evaluative Sciences: ICES Atlas Report 2001, Toronto, Ontario.
44. Lindsay P, Bronskill S, Schull MJ, Chan BT, Anderson GM, Brown AD. Clinical utilization and outcomes. In: Hospital Report 2001: Emergency Department Care. Joint Initiative of the Ontario Hospital Association and the Government of Ontario. Hospital Report Research Collaborative, University of Toronto 2001, Toronto.
45. Hoffman JR, Mower WR, Wolfson AB, Todd K. Selective cervical spine radiography in blunt trauma: The National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med 1998, 32:S1. 10.1016/S0196-0644(98)70176-3, 9739735.
46. Stiell IG, McKnight RD, Wells GA, Lesiuk H, Vandemheen K, Clement C, Worthington JR, Schull M, Reardon M, Morrison L, MacPhail I, Greenberg GH, Eisenhauer M, Dreyer J, Cass DE, Brison R. Application of the Nexus Low-Risk Criteria for cervical spine radiography in Canadian emergency departments. Acad Emerg Med 2000, 7:566.
47. Szucs P, Richman PB, Mandell M. Triage nurse application of the Ottawa knee rule. Acad Emerg Med 2001, 8:112-116. 10.1111/j.1553-2712.2001.tb01274.x, 11157285.
48. Kec RM, Richman PB, Szucs PA, Mandell M, Eskin B. Can Emergency Department triage nurses appropriately utilize the Ottawa Knee Rules to order radiographs? - An implementation trial. Acad Emerg Med 2003, 10:146-150.
49. Wasson JH, Sox HC, Neff RK, Goldman L. Clinical prediction rules: application and methodological standards. N Engl J Med 1985, 313:793-799. 10.1056/NEJM198509263131306, 3897864.
50. Feinstein AR. Clinimetrics. 1987, New Haven: Yale University Press.
51. Laupacis A, Sekar N, Stiell IG. Clinical prediction rules: a review and suggested modifications of methodological standards. JAMA 1997, 277:488-494. 10.1001/jama.277.6.488, 9020274.
52. Stiell IG, Wells GA. Methodologic standards for the development of clinical decision rules in emergency medicine. Ann Emerg Med 1999, 33:437-447. 10.1016/S0196-0644(99)70309-4, 10092723.
53. Lee TH. Evaluating decision aids: the next painful step. J Gen Intern Med 1990, 5:528-529. 10.1007/BF02600886, 2266437.
54. Fischl MA, Pitchenik A, Gardner LB. An index predicting relapse and need for hospitalization in patients with acute bronchial asthma. N Engl J Med 1981, 305:783-799. 10.1056/NEJM198110013051402, 7266631.
55. Rose CC, Murphy JG, Schwartz JS. Performance of an index predicting the response of patients with acute bronchial asthma to intensive emergency department treatment. N Engl J Med 1984, 310:573-577. 10.1056/NEJM198403013100906, 6694708.
56. Centor RM, Yarbrough B, Wood JP. Inability to predict relapse in acute asthma. N Engl J Med 1984, 310:577-580. 10.1056/NEJM198403013100907, 6694709.
57. Charlson ME, Ales KL, Simon R, MacKenzie CR. Why predictive indexes perform less well in validation studies. Arch Intern Med 1987, 147:2155-2161. 10.1001/archinte.147.12.2155, 3689067.
58. Poses RM, Cebul RD, Collins M, Fager SS. The importance of disease prevalence in transporting clinical prediction rules: the case of streptococcal pharyngitis. Ann Intern Med 1986, 105:586-591.
59. Wigton RS, Connor JL, Centor RM. Transportability of a decision rule for the diagnosis of streptococcal pharyngitis. Arch Intern Med 1986, 146:81-83. 10.1001/archinte.146.1.81, 3510600.
60. Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. The Lancet 1993, 342:1317-1322.
61. Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PAC, Rubin HR. Why don't physicians follow clinical practice guidelines?. JAMA 1999, 282:1458-1465. 10.1001/jama.282.15.1458, 10535437.
62. Abboud PAC, Cabana MD. Understanding barriers to the adoption of clinical decision rules (correspondence). Ann Emerg Med 2001, 38:703-704. 10.1067/mem.2001.119945, 11719755.
63. Williams J, Jehle D, Cottington E, Shufflebarger C. Head, facial, and clavicular trauma as a predictor of cervical-spine injury. Ann Emerg Med 1992, 21:719-722. 10.1016/S0196-0644(05)82786-6, 1590614.
64. Frye G, Wolfe T, Knopp R, Lesperance R, Williams J. Intracranial hemorrhage as a predictor of occult cervical-spine fracture. Ann Emerg Med 1994, 23:797-801. 10.1016/S0196-0644(94)70316-7, 8161049.
65. Malomo AO, Shokunbi MT, Adeloye A. Evaluation of the use of plain cervical spine radiography in patients with head injury. East Afr Med J 1995, 72:186-188.
66. Beirne JC, Butler PE, Brady FA. Cervical spine injuries in patients with facial fractures: a 1-year prospective study. Int J Oral Maxillofac Surg 1995, 24:26-29. 10.1016/S0901-5027(05)80852-5, 7782637.
67. Stiell IG, Wells GA, McKnight RD, Brison R, Lesiuk H, Clement C, Eisenhauer MA, Greenberg GH, MacPhail I, Worthington J, Verbeek R, Dreyer J, Cass D, Schull M, Morrison L, Rowe BH, Holroyd BR, Bandiera G, Laupacis A, . C. C. C. Study Group The Canadian C-Spine Rule Study for alert and stable trauma patients: background and rationale. Can J Emerg Med 2002, 4:84-90. C. C. C. Study Group.
68. Hoffman JR, Mower W, Wolfson AB, Todd K, Zucker M. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med 2000, 343:94-99. 10.1056/NEJM200007133430203, 10891516.
69. Hoffman JR, Wolfson AB, Todd K, Mower WR. Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med 1998, 32:461-469. 10.1016/S0196-0644(98)70176-3, 9774931.
70. Stiell IG, Clement C, McKnight RD, Wells GA, Brison R, Schull MJ, Rowe BH, Worthington JR, Eisenhauer MA, Cass D, Greenberg GH, MacPhail I, Dreyer J, Lee JS, Bandiera G, Reardon M, Holroyd BR, Lesiuk H. Comparative Validation of the Canadian C-Spine Rule and the NEXUS Low-Risk Criteria in Alert and Stable Trauma Patients. N Engl J Med 2003, 349:2510-2518. 10.1056/NEJMoa031375, 14695411.
71. Hauswald M, Ong G, Tandberg D, Omar Z. Out-of-hospital spinal immobilization: its effect on neurologic injury. Acad Emerg Med 1998, 5:214-219. 10.1111/j.1553-2712.1998.tb02615.x, 9523928.
72. Domeier RM, Frederiksen SM, Welch K. Prospective performance assessment of an out-of-hospital protocol for selective spine immobilization using clinical spine clearance criteria. Ann Emerg Med 2005, 46:123-131. 10.1016/j.annemergmed.2005.02.004, 16046941.
73. Stroh G, Braude D. Can an out-of-hospital cervical spine clearance protocol identify all patients with injuries? An argument for selective immobilization. Ann Emerg Med 2001, 37:609-615. 10.1067/mem.2001.114409, 11385329.
74. Muhr MD, Seabrook DL, Wittwer LK. Paramedic use of a spinal injury clearance algorithm reduces spinal immobilization in the out-of-hospital setting. Prehospital Emergency Care 1999, 3:1-6. 10.1080/10903129908958895, 9921731.
75. Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, De Maio VJ, Laupacis A, Schull M, McKnight RD, Verbeek R, Brison R, Cass D, Dreyer J, Eisenhauer MA, Greenberg GH, MacPhail I, Morrison L, Reardon M, Worthington J. The Canadian Cervical Spine Radiography Rule for alert and stable trauma patients. JAMA 2001, 286:1841-1848. 10.1001/jama.286.15.1841, 11597285.
76. Stiell IG, Clement CM, Grimshaw J, Brison RJ, Rowe BH, Schull MJ, Lee JS, Brehaut J, McKnight RD, Eisenhauer MA, Dreyer J, Letovsky E, Rutledge T, MacPhail I, Ross S, Shah A, Perry JJ, Holroyd BR, Ip U, Lesiuk H, Wells GA. Implementation of the Canadian C-Spine Rule: prospective 12 centre cluster randomised trial. BMJ 2009, 339.
77. Vaillancourt C, Stiell IG, Beaudoin T, Maloney J, Anton AR, Bradford P, Cain E, Travers A, Stempien M, Lees M, Munkley D, Battram E, Banek J, Wells GA. The Out-of-Hospital Validation of the Canadian C-Spine Rule by Paramedics. Ann Emerg Med 2009, 54:663-671. 10.1016/j.annemergmed.2009.03.008, 19394111.
78. Stiell IG, Vandemheen K, Brison R, Cass DE, Dreyer J, Eisenhauer MA, Greenberg GH, MacPhail I, McKnight RD, Reardon M, Verbeek RP, Worthington JR, Wells GA, Laupacis A, Lesiuk H. Validity evaluation of the cervical spine injury proxy outcome assessment tool in the CCC Study. Acad Emerg Med 1999, 6:434.
79. Stiell IG, Clement CM, O'Connor A, Davies B, Leclair C, Sheehan P, Clavet T, Beland C, MacKenzie T, Wells GA. Multicentre prospective validation of use of the Canadian C-Spine Rule by triage nurses in the emergency department. CMAJ 2010, 182:1173-1179. 10.1503/cmaj.091430, 2917929, 20457772.
80. Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet 1974, 2:81-84. 10.1016/S0140-6736(74)91639-0, 4136544.