Sw. Meldon et al., Out-of-hospital cervical spine clearance: Agreement between emergency medical technicians and emergency physicians, J TRAUMA, 45(6), 1998, pp. 1058-1061
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.