Prospective validation of out-of-hospital spinal clearance criteria: a preliminary report.

were excluded. Patients for whom outcome information was not obtained also were excluded. Methods bulance services transporting to 7 hospitals in 3 counties in southeastern Michi-Study Design: We performed a mul-To Edi'oc-sPinal injury is ticenter, prospective, out-of-hospital, ob-gan. Three of the hospitals treat major one of the most devastating potential out-servational study to estimate the test per-trauma patients, including spinal cord incomes of trauma. The annual incidence of fomance of key historical and physical jury patients. The other 4 hospitals trans-spinal cord injuries in the United States is findings for prediction of spinal fractures. fer spinal injury patients to 2 of the estimated to be between 8,000 and 10,000 The current out-of-hospital treatment of trauma centers included in this study. All new cases.'.' Out-of-hospital spinal im-the study population was not changed for study sites service a mix of urban and ru-mobilization is performed to prevent new the purpose of this study. The decision to ral populations. A mixture of basic, ad-or worsened spinal cord injury during perform spinal immobilization was based vanced, and air ambulance transporting transportation in patients with unstable on mechanism of injury. By local EMS services participated in the study. spinal fractures. There are currently no system protocol, any patient with a mech-Data collection began April 1, 1994. widely accepted clinical criteria in use to anism of injury that could potentially This preliminary report describes the first determine which patients require spinal a spinal fracture or cord injury was 2,102 completed cases, entered between immobilization and which ones can be immobilized. The study was approved by April 1 and December 21, 1994. We es-transported to the hospital for evaluation the st. ~~~~~h M~~~~ ~ ~ ~ ~ i ~ l clinical timate that 10,000 cases will be needed to without immobilization. This decision is Research Committee, the Washtenaw-capture our target of I00 cervical frac-currently made primarily based on the Livingston county Medical control Board, tures. mechanism of injury. and the university of Michigan Medical Measurements: Out-of-hospital trans-While the literature supports using Center Institutional ~~~i~~ Board (IRB). porting ambulance personnel completed a criteria to clear the spine clinically in the similar IRB was obtained at standardized data questionnaire for all pa-ED? the out-of-hospital use of these cri-other participating centers. N~ tients w h o met the study inclusion criteria teria by paramedical personnel has not was necessary given the observational de-(i.e., sustained an injury warranting stan-been validated. There …