Efficacy and compliance of a prehospital spinal immobilization guideline

BACKGROUND: Prehospital spinal immobilization criteria are useful in identifying those at risk for spinal fractures, while reducing the number of patients unnecessarily immobilized. The use of immobilization criteria, without regard to mechanism of injury, has been shown to accomplish this task. AIMS: The study’s purpose is to examine efficacy of a prehospital spinal clearance guideline and triage/management of these injuries. METHODS: This was a retrospective study of traumatically injured patients based on a clinical clearance spinal immobilization guideline between January 2006 and January 2007. Two gold standards were used in the analysis (radiographic findings and physician clearance without radiographs). This project was approved by the Mayo Clinic Institutional Review Board. RESULTS: The study included 942 patients documented to have a traumatic injury. Of these, 43 (4.6%) had an acute spinal fracture. The guideline allowed 558 (59.2%) patients to be cleared, and 1.3% (7/558) had fractures. The remaining 384 did not meet clearance criteria and accounted for 36 (9.4%, 36/384) fractures. The guideline correctly predicted 36 of 43 fractures. The median age of the 7 fractures not immobilized was 82 years and of the 36 patients with fractures that were immobilized was 48 years. When immobilization was indicated, caregivers were 77.6% (298/384) compliant. Of the noncompliant 22.4% (86/384) there were 9 fractures. CONCLUSIONS: This spinal guideline demonstrates efficacy in identifying those at risk for spinal fractures. An age extreme criteria may enhance this already effective guideline. Further analysis of compliance failures may improve the guideline’s ability for fracture prediction.