Out-of-hospital cervical spine clearance: Agreement between emergency medical technicians and emergency physicians

Objective: Determine the level of agreement between emergency medical techn icians (EMTs) and emergency physicians EPs) when applying an existing emerg ency medical services/fire department protocol for out-of-hospital clinical cervical spine injury (CSI) clearance in blunt trauma patients. Methods: Prospective observational study of consecutive blunt trauma patien ts transported by emergency medical services/fire department during a 3-mon th study period. The setting was an urban Level I trauma center. Measuremen t of terrater agreement (kappa) was determined. Results: Mean age of the 190 patients was 34 +/- 19 years range, 6-98 years ). Fifty-nine percent of the patients were male.,ne hundred forty-six patie nts (77%) were immobilized by MTs; 17 of these patients were clinically cle ared by EPs, Forty,ur patients (23%) were clinically cleared by EMTs and pr esented without CSI precautions; of these, 61% (27 of 44) were immobilized by EPs and 57% (25 of 44) had cervical spine radiographs obtained. Overall, 141 patients (74%) required radiographic clearance. CSI were detected in f ive patients (2.6%); all five were immobilized in the out-of-hospital setti ng. Overall disagreement between EMTs and EPs regarding out-of hospital CSI clearance occurred in 44 patients (23%) (K = 0.29; 95% confidence interval , 0.15-0.43; p < 0.01). Conclusion: Significant disagreement in clinical CSI clearance exists betwe en EMTs and EPs. Further research and education is recommended before wides pread implementation of this practice.