ABSTRACTS
The Association Between Negative Prehospital Spinal Motion Restriction Screening and Spinal Cord InjuryAuthor: Alyssa M. Green, BA | | Associate Authors:
Introduction/Background Prehospital spinal motion restriction (SMR) is no longer recommended for patients unlikely to have unstable spinal injuries. The National Emergency X-ray Utilization Study (NEXUS) criteria are often used by EMS clinicians to “clear” patients with presumed low risk for spinal injury and thus not apply SMR. The ability of NEXUS to correctly identify prehospital patients without spinal cord injuries (SCI) is unknown. Objective Our objective was to examine the association between negative prehospital NEXUS criteria and SCI requiring hospital admission. Methods This retrospective analysis used the 2021 ESO Data Collaborative dataset to analyze linked prehospital and hospital records for trauma patients from 9-1-1 activations. Patients admitted with spinal cord injuries were identified using ICD-10 diagnosis codes. An age-adjusted logistic regression model was used to analyze the relationship between SCI and NEXUS criteria, overall and by components. Results We analyzed 288,309 EMS encounters for trauma patients with hospital outcomes. SCI occurred in 197 (< 0.01%) patients with 164 resulting hospital admission. Among admitted patients with SCI, 64 (39%) had a documented prehospital NEXUS SMR screen. Of these, 9 (14%) had a negative prehospital SMR screen. After adjustment for age, a negative SMR screen was associated with lower odds of SCI, aOR 0.14 (0.060.27); however, the sensitivity of a negative SMR screen was only 86% (75%-93%). Conclusions Although a negative prehospital SMR screen using NEXUS criteria was associated with reduced odds of SCI, there was a 14% false negative rate. NEXUS criteria may be inadequately sensitive to evaluate the need for prehospital SMR. Limitations include potential documentation errors and use of a convenience sample.
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