Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Aug;44(4):551-554.
doi: 10.1007/s00068-017-0828-0. Epub 2017 Aug 5.

Value of prehospital assessment of spine fracture by paramedics

J G Ten Brinke  1 , W K Gebbink  2 , L Pallada  2 , T P Saltzherr  3 , M Hogervorst  2 , J C Goslings  3
Affiliations

Value of prehospital assessment of spine fracture by paramedics

J G Ten Brinke et al. Eur J Trauma Emerg Surg. 2018 Aug.

Abstract

Background: Current guidelines state that trauma patients at risk of spine injury should undergo prehospital spine immobilization to reduce the risk of neurological deterioration. Although this approach has been accepted and implemented as a standard for decades, there is little scientific evidence to support it. Furthermore, the potential dangers and sequelae of spine immobilization have been extensively reported. The role of the paramedic in this process has not yet been examined. The aim of this study was to evaluate the accuracy of prehospital evaluations for the presence of spine fractures made by paramedics.

Methods: All patients who presented with prehospital spine immobilization at our level II trauma center between January 2013 and January 2014 were prospectively included in a database. Prior to the diagnosis, paramedics recorded the probability of a spine fracture after a prehospital examination. These predictions were compared with patient outcomes. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated.

Results: One hundred and thirty-nine patients were included that positive predictive value was 22%, negative predictive value was 95%, sensitivity was 92%, specificity was 30%, and accuracy was 41%.

Conclusions: The results of this study suggest that paramedics cannot accurately predict spinal fractures.

Keywords: Emergency medical services; Predictive value; Prehospital; Spinal fracture.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest

Joost ten Brinke, Wieke Klein Gebbink, Len Pallada, Teun Saltzherr, Mike Hogervorst, and Carel Goslings have no conflict of interest. The manuscript is not under consideration for publication elsewhere.

Human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

Informed consent was not obtained from all patients for inclusion in the study because of the design of this study, namely, an observational database study.

Figures

Fig. 1
Fig. 1
Flow diagram of patient inclusion and fracture prediction
See this image and copyright information in PMC

References

    1. Landelijk protocol ambulancezorg versie 8,1. 2016.
    1. PHTLS: Prehospital Trauma Life Support. 8 ed.
    1. Kreinest M, et al. Development of a new Emergency Medicine Spinal Immobilization Protocol for trauma patients and a test of applicability by German emergency care providers. Scand J Trauma Resusc Emerg Med. 2016;24:71. doi: 10.1186/s13049-016-0267-7. - DOI - PMC - PubMed
    1. Theodore N, et al. Prehospital cervical spinal immobilization after trauma. Neurosurgery. 2013;72(Suppl 2):22–34. doi: 10.1227/NEU.0b013e318276edb1. - DOI - PubMed
    1. Unfallchirurgie DGf. S3–Leitlinie Polytrauma/Schwerverletzten-Behandlung. 2011.

LinkOut - more resources