Research Article: Immobilization in Emergency Medical Service – Are CSR and NEXUS-Criteria Considered? A Matched-Pairs Analysis Between Trauma Patients Treated by Onsite EMS Physicians and Patients Treated by Tele-EMS Physicians
Abstract:
Although the NEXUS-Low-risk criteria (NEXUS) and the Canadian C-spine rule (CSR) have been published almost years ago, and have been adopted into many guidelines worldwide,, the prehospital clearance of the cervical spine and the choice of the immobilization-device are still controversially discussed topics due to the lack of evidence.– The NEXUS-criteria published in by Hofmann et al and validated for the out-of-hospital spinal clearance in by Domeier et al include the following five major criteria: the absence of cervical spine tenderness, no focal neurological deficit, normal level of consciousness and the absence of intoxication and distracting painful injury., In , Stiell et al published the CSR as an alternative clinical decision tool. It defines three high-risk factors (age ? years, dangerous mechanism of injury, paresthesias in the extremities) that require radiological imaging to rule out a spinal fracture. Furthermore, it defines four low-risk factors (sitting position in the ED, ambulatory treatment, delayed onset of neck pain, absence of C-Spine tenderness) that allow a safe assessment of the spine. If the patient can rotate his head ° left and right, the cervical spine can be cleared without imaging. Recent studies show that despite the presence of these criteria, trauma patients are immobilized rather conservatively due to the concern of causing secondary damage to the spine., It is discussed, if the criteria “distracting injury” leads to unnecessary immobilization, due to the lack of clear evidence about the kind of injury, that should be considered as distracting.,
Introduction:
Although the NEXUS-Low-risk criteria (NEXUS) and the Canadian C-spine rule (CSR) have been published almost years ago, and have been adopted into many guidelines worldwide, , the prehospital clearance of the cervical spine and the choice of the immobilization-device are still controversially discussed topics due to the lack of evidence. – The NEXUS-criteria published in by Hofmann et al and validated for the out-of-hospital spinal clearance in by Domeier et al include the following five major criteria: the absence…
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