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

Background

The NEXUS-low-risk criteria (NEXUS) and Canadian C-spine rule (CSR) are clinical decision tools used for the prehospital spinal clearance in trauma patients, intending to prevent over- as well as under immobilization. Since 2014, a holistic telemedicine system is part of the emergency medical service (EMS) in Aachen (Germany). This study aims to examine whether the decisions to immobilize or not by EMS- and tele-EMS physicians are based on NEXUS and the CSR, as well as the guideline adherence concerning the choice of immobilization device.

Methods

A single-site retrospective chart review was undertaken. Inclusion criteria were EMS physician and tele-EMS physician protocols with traumatic diagnoses. Matched pairs were formed, using age, sex and working diagnoses as matching criteria. The primary outcome parameters were the criteria documented as well as the immobilization device used. The evaluation of the decision to immobilize based on the criteria documented was defined as secondary outcome parameter.

Results

Of a total of 247 patients, 34% (n = 84) were immobilized in the EMS physician group and 32.79% (n = 81) in the tele-EMS physician group. In both groups, less than 7% NEXUS or CSR criteria were documented completely. The decision to immobilize or not was appropriately implemented in 127 (51%) in the EMS-physician and in 135 (54, 66%) in the tele-EMS physician group. Immobilization without indication was performed significantly more often by tele-EMS physicians (6.88% vs 2.02%). A significantly better guideline adherence was found in the tele-EMS physician group, preferring the vacuum mattress (25, 1% vs 8.9%) over the spineboard.

Conclusion

It could be shown that NEXUS and CSR are not applied regularly, and if so, mostly inconsistently with incomplete documentation by both EMS- and tele-EMS physicians. Regarding the choice of the immobilization device a higher guideline adherence was shown among the tele-EMS physicians.

Keywords:

• immobilization
• trauma
• emergency medicine
• Canadian C-spine rule
• NEXUS-criteria
• tele-emergency medicine

Data Sharing Statement

The datasets analyzed during the current study are not publicly available due to the fact that the datasets are municipal property and can therefore not be published online under open access agreements. However, the datasets are available on reasonable request and with the permission of the municipal authorities.

Ethics Approval and Consent to Participate

The study was assessed by the medical faculty’s ethics committee at RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany (Number of approval: 357/17) as unobjectionable. The ethics committee, the university research board (Center for Translational and Clinical Research), and data protection officers granted the analysis of the data for quality assurance purposes and waived the requirement of informed consent from patients.

Acknowledgments

We thank Michèle Twomey for the language editing and Markus Kirch for his technical support during the data analysis.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data. PH wrote the entire manuscript, all other authors took part in revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

The present study did not receive any external funding.