Immobilization in Emergency Medical Service - Are CSR and NEXUS-Criteria Considered? A Matched-Pairs Analysis Between Trauma Patients Treated by Onsite EMS Physicians and Patients Treated by Tele-EMS Physicians.
Canadian C-spine rule
NEXUS-criteria
emergency medicine
immobilization
tele-emergency medicine
trauma
Journal
Open access emergency medicine : OAEM
ISSN: 1179-1500
Titre abrégé: Open Access Emerg Med
Pays: New Zealand
ID NLM: 101570796
Informations de publication
Date de publication:
2023
2023
Historique:
received:
17
09
2022
accepted:
28
03
2023
medline:
16
5
2023
pubmed:
16
5
2023
entrez:
15
5
2023
Statut:
epublish
Résumé
The NEXUS-low-risk criteria (NEXUS) and Canadian C-spine rule (CSR) are clinical decision tools used for the prehospital spinal clearance in trauma patients, intending to prevent over- as well as under immobilization. Since 2014, a holistic telemedicine system is part of the emergency medical service (EMS) in Aachen (Germany). This study aims to examine whether the decisions to immobilize or not by EMS- and tele-EMS physicians are based on NEXUS and the CSR, as well as the guideline adherence concerning the choice of immobilization device. A single-site retrospective chart review was undertaken. Inclusion criteria were EMS physician and tele-EMS physician protocols with traumatic diagnoses. Matched pairs were formed, using age, sex and working diagnoses as matching criteria. The primary outcome parameters were the criteria documented as well as the immobilization device used. The evaluation of the decision to immobilize based on the criteria documented was defined as secondary outcome parameter. Of a total of 247 patients, 34% (n = 84) were immobilized in the EMS physician group and 32.79% (n = 81) in the tele-EMS physician group. In both groups, less than 7% NEXUS or CSR criteria were documented completely. The decision to immobilize or not was appropriately implemented in 127 (51%) in the EMS-physician and in 135 (54, 66%) in the tele-EMS physician group. Immobilization without indication was performed significantly more often by tele-EMS physicians (6.88% vs 2.02%). A significantly better guideline adherence was found in the tele-EMS physician group, preferring the vacuum mattress (25, 1% vs 8.9%) over the spineboard. It could be shown that NEXUS and CSR are not applied regularly, and if so, mostly inconsistently with incomplete documentation by both EMS- and tele-EMS physicians. Regarding the choice of the immobilization device a higher guideline adherence was shown among the tele-EMS physicians.
Sections du résumé
Background
UNASSIGNED
The NEXUS-low-risk criteria (NEXUS) and Canadian C-spine rule (CSR) are clinical decision tools used for the prehospital spinal clearance in trauma patients, intending to prevent over- as well as under immobilization. Since 2014, a holistic telemedicine system is part of the emergency medical service (EMS) in Aachen (Germany). This study aims to examine whether the decisions to immobilize or not by EMS- and tele-EMS physicians are based on NEXUS and the CSR, as well as the guideline adherence concerning the choice of immobilization device.
Methods
UNASSIGNED
A single-site retrospective chart review was undertaken. Inclusion criteria were EMS physician and tele-EMS physician protocols with traumatic diagnoses. Matched pairs were formed, using age, sex and working diagnoses as matching criteria. The primary outcome parameters were the criteria documented as well as the immobilization device used. The evaluation of the decision to immobilize based on the criteria documented was defined as secondary outcome parameter.
Results
UNASSIGNED
Of a total of 247 patients, 34% (n = 84) were immobilized in the EMS physician group and 32.79% (n = 81) in the tele-EMS physician group. In both groups, less than 7% NEXUS or CSR criteria were documented completely. The decision to immobilize or not was appropriately implemented in 127 (51%) in the EMS-physician and in 135 (54, 66%) in the tele-EMS physician group. Immobilization without indication was performed significantly more often by tele-EMS physicians (6.88% vs 2.02%). A significantly better guideline adherence was found in the tele-EMS physician group, preferring the vacuum mattress (25, 1% vs 8.9%) over the spineboard.
Conclusion
UNASSIGNED
It could be shown that NEXUS and CSR are not applied regularly, and if so, mostly inconsistently with incomplete documentation by both EMS- and tele-EMS physicians. Regarding the choice of the immobilization device a higher guideline adherence was shown among the tele-EMS physicians.
Identifiants
pubmed: 37187612
doi: 10.2147/OAEM.S386650
pii: 386650
pmc: PMC10178902
doi:
Types de publication
Journal Article
Langues
eng
Pagination
145-155Informations de copyright
© 2023 Hofstetter et al.
Déclaration de conflit d'intérêts
The authors declare that they have no competing interests.
Références
J Trauma Acute Care Surg. 2012 Aug;73(2):498-502
pubmed: 23019677
JAMA. 2001 Oct 17;286(15):1841-8
pubmed: 11597285
Surgeon. 2010 Aug;8(4):218-22
pubmed: 20569942
Emerg Med J. 2013 Dec;30(12):1067-9
pubmed: 24232011
J Emerg Nurs. 2018 Jul;44(4):368-374
pubmed: 29203049
Spine (Phila Pa 1976). 2015 Dec;40(24):1898-902
pubmed: 26352743
PLoS One. 2018 Nov 2;13(11):e0206283
pubmed: 30388133
Am J Emerg Med. 2015 Dec;33(12):1750-4
pubmed: 26346048
Anasthesiol Intensivmed Notfallmed Schmerzther. 2017 Feb;52(2):107-117
pubmed: 28222471
Prehosp Emerg Care. 1999 Jan-Mar;3(1):1-6
pubmed: 9921731
Ann Emerg Med. 2006 Jan;47(1):110-2
pubmed: 16395778
Ann Emerg Med. 2003 Sep;42(3):395-402
pubmed: 12944893
Scand J Trauma Resusc Emerg Med. 2017 Jan 5;25(1):2
pubmed: 28057029
Health Informatics J. 2019 Dec;25(4):1528-1537
pubmed: 29865891
J Telemed Telecare. 2017 Apr;23(3):402-409
pubmed: 27080747
N Engl J Med. 2000 Jul 13;343(2):94-9
pubmed: 10891516
Cochrane Database Syst Rev. 2001;(2):CD002803
pubmed: 11406043
Anaesthesist. 2011 Mar;60(3):221-9
pubmed: 20852833
J Trauma. 2002 Oct;53(4):744-50
pubmed: 12394877
J Clin Hypertens (Greenwich). 2017 Jul;19(7):704-712
pubmed: 28560799