| dc.description.abstract | Background:
Patients after blunt trauma are being spinal immobilized by ambulance staff if they meet the high risk criteria for spinal column injury. Spinal immobilization is not a benign procedure and can result in different (life threatening) adverse effects.
Objective:
To provide insight into the characteristics of pre-hospital spinal immobilized patients after blunt trauma and to determine is ambulance staff is compliant in following the current guidelines of spinal immobilization. .
Research questions:
What are the characteristics of spinal immobilized patients after blunt trauma and how was emergency care by ambulance staff provided, in terms of eight different variables? Are there measurable changes in characteristics over the years?
Study Method:
Pre-hospital electronic patient records (≥ 18 years) were retrospectively collected from 2008 through 2012. Descriptive statistics were used to present data, chi-square and independent t- test describing differences in variables.
Results:
A total of 1082 patients were analyzed, of which 37,2% had suspicion of spinal column injuries and 5,7% showed symptoms of spinal cord injury. In the population 46,8% received spinal immobilization, but without neck/back pain. Partial immobilization was documented in 16%. Main reasons were: breathing problems, inappropriate fitting collar, clavicle or jaw fractures and combativeness of the patient. No difference in application of a rigid collar in patients with or without high intracranial pressure (p=0,286). Reported adverse effects: vomiting or nausea (7,1%), pain (0,1%), shortness of breath (0,3%) and agitation (0,3%).
Conclusion / Recommendation
Unnecessary spinal immobilization is rare, but partial immobilization is coded frequently. Adherence to the spinal immobilization guideline in traumatic brain injury is lacking, and the definition of distracting injury remains unclear. Progression in time of spinal cord injury cannot be tested by ambulance staff. Finally, documentation by ambulance nurses must be more complete. | |
