Prehospital Protocols Reducing Long Spinal Board Use Are Not Associated with a Change in Incidence of Spinal Cord Injury

Franco Castro-Marin, Joshua B. Gaither, Amber D. Rice, Robyn N. Blust, Vatsal Chikani, Anne Vossbrink, Bentley J. Bobrow

Research output: Contribution to journalArticle

Abstract

Introduction: Many emergency medical services (EMS) agencies have de-emphasized or eliminated the use of long spinal boards (LSB) for patients with possible spinal injury. We sought to determine if implementation of spinal motion restriction (SMR) protocols, which reduce LSB use, was associated with an increase in spinal cord injury (SCI). Methods: This retrospective observational study includes EMS encounters from January 1, 2013 to December 31, 2015 submitted by SMR-adopting ground-based agencies to a state EMS database with hospital discharge data. Encounters were excluded if SMR implementation date was unknown, occurred during a 3-month run-in period, or were duplicates. Study samples include patients with traumatic injury (TI), possible spinal trauma (P-ST), and verified spinal trauma (V-ST) using hospital discharge ICD-9/10 diagnosis codes. The incidence of SCI before and after implementation of SMR was compared using Chi-squared and logistic regression. Results: From 1,005,978 linked encounters, 104,315 unique encounters with traumatic injury and known SMR implementation date were identified with 51,199 cases of P-ST and 5,178 V-ST cases. The incidence of SCI in the pre-SMR and post-SMR interval for each group was: TI, 0.20% vs. 0.22% (p = 0.390); P-ST, 0.40% vs. 0.45% (p = 0.436); and V-ST, 4.04% vs. 4.37% (p = 0.561). Age and injury severity adjusted odds ratio of SCI in the highest risk cohort of patients with V-ST was 1.097 after SMR implementation (95% CI 0.818–1.472). Conclusion: In this limited study, no change in the incidence of SCI was identified following implementation of SMR protocols. Prospective evaluation of this question is necessary to evaluate the safety of SMR protocols.

Original languageEnglish (US)
JournalPrehospital Emergency Care
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Spinal Cord Injuries
Incidence
Wounds and Injuries
Spinal Injuries
Emergency Medical Services
International Classification of Diseases
Observational Studies
Retrospective Studies
Logistic Models
Odds Ratio
Databases
Safety

Keywords

  • emergency medical services
  • long spinal board
  • spinal cord injury
  • spinal immobilization
  • spinal motion restriction

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Prehospital Protocols Reducing Long Spinal Board Use Are Not Associated with a Change in Incidence of Spinal Cord Injury. / Castro-Marin, Franco; Gaither, Joshua B.; Rice, Amber D.; N. Blust, Robyn; Chikani, Vatsal; Vossbrink, Anne; Bobrow, Bentley J.

In: Prehospital Emergency Care, 01.01.2019.

Research output: Contribution to journalArticle

@article{55350cd51941467fbf4a9e5c96c0134e,
title = "Prehospital Protocols Reducing Long Spinal Board Use Are Not Associated with a Change in Incidence of Spinal Cord Injury",
abstract = "Introduction: Many emergency medical services (EMS) agencies have de-emphasized or eliminated the use of long spinal boards (LSB) for patients with possible spinal injury. We sought to determine if implementation of spinal motion restriction (SMR) protocols, which reduce LSB use, was associated with an increase in spinal cord injury (SCI). Methods: This retrospective observational study includes EMS encounters from January 1, 2013 to December 31, 2015 submitted by SMR-adopting ground-based agencies to a state EMS database with hospital discharge data. Encounters were excluded if SMR implementation date was unknown, occurred during a 3-month run-in period, or were duplicates. Study samples include patients with traumatic injury (TI), possible spinal trauma (P-ST), and verified spinal trauma (V-ST) using hospital discharge ICD-9/10 diagnosis codes. The incidence of SCI before and after implementation of SMR was compared using Chi-squared and logistic regression. Results: From 1,005,978 linked encounters, 104,315 unique encounters with traumatic injury and known SMR implementation date were identified with 51,199 cases of P-ST and 5,178 V-ST cases. The incidence of SCI in the pre-SMR and post-SMR interval for each group was: TI, 0.20{\%} vs. 0.22{\%} (p = 0.390); P-ST, 0.40{\%} vs. 0.45{\%} (p = 0.436); and V-ST, 4.04{\%} vs. 4.37{\%} (p = 0.561). Age and injury severity adjusted odds ratio of SCI in the highest risk cohort of patients with V-ST was 1.097 after SMR implementation (95{\%} CI 0.818–1.472). Conclusion: In this limited study, no change in the incidence of SCI was identified following implementation of SMR protocols. Prospective evaluation of this question is necessary to evaluate the safety of SMR protocols.",
keywords = "emergency medical services, long spinal board, spinal cord injury, spinal immobilization, spinal motion restriction",
author = "Franco Castro-Marin and Gaither, {Joshua B.} and Rice, {Amber D.} and {N. Blust}, Robyn and Vatsal Chikani and Anne Vossbrink and Bobrow, {Bentley J.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1080/10903127.2019.1645923",
language = "English (US)",
journal = "Prehospital Emergency Care",
issn = "1090-3127",
publisher = "Informa Healthcare",

}

TY - JOUR

T1 - Prehospital Protocols Reducing Long Spinal Board Use Are Not Associated with a Change in Incidence of Spinal Cord Injury

AU - Castro-Marin, Franco

AU - Gaither, Joshua B.

AU - Rice, Amber D.

AU - N. Blust, Robyn

AU - Chikani, Vatsal

AU - Vossbrink, Anne

AU - Bobrow, Bentley J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Many emergency medical services (EMS) agencies have de-emphasized or eliminated the use of long spinal boards (LSB) for patients with possible spinal injury. We sought to determine if implementation of spinal motion restriction (SMR) protocols, which reduce LSB use, was associated with an increase in spinal cord injury (SCI). Methods: This retrospective observational study includes EMS encounters from January 1, 2013 to December 31, 2015 submitted by SMR-adopting ground-based agencies to a state EMS database with hospital discharge data. Encounters were excluded if SMR implementation date was unknown, occurred during a 3-month run-in period, or were duplicates. Study samples include patients with traumatic injury (TI), possible spinal trauma (P-ST), and verified spinal trauma (V-ST) using hospital discharge ICD-9/10 diagnosis codes. The incidence of SCI before and after implementation of SMR was compared using Chi-squared and logistic regression. Results: From 1,005,978 linked encounters, 104,315 unique encounters with traumatic injury and known SMR implementation date were identified with 51,199 cases of P-ST and 5,178 V-ST cases. The incidence of SCI in the pre-SMR and post-SMR interval for each group was: TI, 0.20% vs. 0.22% (p = 0.390); P-ST, 0.40% vs. 0.45% (p = 0.436); and V-ST, 4.04% vs. 4.37% (p = 0.561). Age and injury severity adjusted odds ratio of SCI in the highest risk cohort of patients with V-ST was 1.097 after SMR implementation (95% CI 0.818–1.472). Conclusion: In this limited study, no change in the incidence of SCI was identified following implementation of SMR protocols. Prospective evaluation of this question is necessary to evaluate the safety of SMR protocols.

AB - Introduction: Many emergency medical services (EMS) agencies have de-emphasized or eliminated the use of long spinal boards (LSB) for patients with possible spinal injury. We sought to determine if implementation of spinal motion restriction (SMR) protocols, which reduce LSB use, was associated with an increase in spinal cord injury (SCI). Methods: This retrospective observational study includes EMS encounters from January 1, 2013 to December 31, 2015 submitted by SMR-adopting ground-based agencies to a state EMS database with hospital discharge data. Encounters were excluded if SMR implementation date was unknown, occurred during a 3-month run-in period, or were duplicates. Study samples include patients with traumatic injury (TI), possible spinal trauma (P-ST), and verified spinal trauma (V-ST) using hospital discharge ICD-9/10 diagnosis codes. The incidence of SCI before and after implementation of SMR was compared using Chi-squared and logistic regression. Results: From 1,005,978 linked encounters, 104,315 unique encounters with traumatic injury and known SMR implementation date were identified with 51,199 cases of P-ST and 5,178 V-ST cases. The incidence of SCI in the pre-SMR and post-SMR interval for each group was: TI, 0.20% vs. 0.22% (p = 0.390); P-ST, 0.40% vs. 0.45% (p = 0.436); and V-ST, 4.04% vs. 4.37% (p = 0.561). Age and injury severity adjusted odds ratio of SCI in the highest risk cohort of patients with V-ST was 1.097 after SMR implementation (95% CI 0.818–1.472). Conclusion: In this limited study, no change in the incidence of SCI was identified following implementation of SMR protocols. Prospective evaluation of this question is necessary to evaluate the safety of SMR protocols.

KW - emergency medical services

KW - long spinal board

KW - spinal cord injury

KW - spinal immobilization

KW - spinal motion restriction

UR - http://www.scopus.com/inward/record.url?scp=85070890122&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070890122&partnerID=8YFLogxK

U2 - 10.1080/10903127.2019.1645923

DO - 10.1080/10903127.2019.1645923

M3 - Article

AN - SCOPUS:85070890122

JO - Prehospital Emergency Care

JF - Prehospital Emergency Care

SN - 1090-3127

ER -