NEW YORK (Reuters Health) – In trauma patients with possible neck injury, paramedics can apply the Canadian C-Spine Rule to reliably avoid unnecessary spinal immobilization “without missing any important cervical spine injuries,” results of a prospective study indicate.

“Cervical spine immobilization in the field is often unnecessary, is time intensive for paramedics in the field and is very uncomfortable for patients,” Dr. Christian Vaillancourt from Ottawa Health Research Institute, Ontario and colleagues note in the Annals of Emergency Medicine for November.

To identify neck injury, the Canadian C-Spine Rule uses three high-risk criteria (age 65 or older, “dangerous” trauma mechanism, and numbness or tingling in extremities), four low-risk criteria (rear-end motor vehicle crash, ambulatory at any time at scene, no neck pain at the scene, absence of midline c-spine tenderness), and patients’ ability to rotate their neck.

Dr. Vaillancourt and colleagues previously derived and validated the rule in two large multicenter studies involving 17,207 alert and stable trauma patients in the ED. The current study, they say, demonstrates for the first time that the rule can be used reliably by paramedics in the field to clear the cervical spine in a few minutes in alert and stable trauma patients for whom cervical spine injury is a concern.

In this 1,949-patient cohort, paramedics achieved 100% sensitivity (and 100% negative predictive value) for classifying important cervical fractures in trauma patients, most of whom had been in a motor vehicle crash (62.5%) or suffered a fall (19.9%).

Despite only a short tutorial on how to use and interpret the Canadian C-Spine Rule, paramedics were able to correctly identify all 12 trauma victims who had a clinically important cervical spine injury, the authors report.

In the current study, all patients were immobilized for transport to the hospital, no matter what the new tool predicted. Many of these immobilizations, the researchers say, could have been avoided had the paramedics been allowed to make clinical decisions based on their interpretation of the rule.

“More safety data is required before a selective immobilization strategy is broadly implemented,” Dr. Vaillancourt told Reuters Health. “We have recently submitted another grant application to implement the C-Spine rule and allow Ottawa paramedics to transport selected trauma victims without cervical spine immobilization.”

Reference:
Ann Emerg Med 2009;54:663-671.