Studio osservazionale in merito alla validità della Canadian C-Spine Rule in ambito extra ospedaliero

Nicolò Bravi, Lara Marchetti, Stefano Musolesi

Abstract

Introduzione: In ambito extra ospedaliero è pratica comune applicare un collare cervicale ad ogni soggetto vittima di trauma. Per molti di loro tale pratica può rappresentare un trattamento eccessivo e in alcuni casi un evento avverso, inoltre può portare a svolgere superflui esami diagnostici. In considerazione degli sviluppi scientifici è opportuno chiedersi se l’utilizzo ‘routinario’ del collare cervicale debba essere riconsiderato. Obiettivo: Analizzare l’appropriatezza della Canadian C-Spine Rule (CCR) come elemento predittivo per l’utilizzo o meno del collare cervicale. Metodi: E’ stata effettuata un'indagine retrospettiva sui pazienti ammessi al Pronto Soccorso degli ospedali di Ravenna, Cesena e San Marino dal 1 Aprile 2017 al 31 Agosto 2017. I pazienti giunti in Pronto Soccorso, vittime di trauma a cui era stato posizionato il collare cervicale, sono stati sopposti a una valutazione Canadian C-Spine Rule (CCR) al fine di verificarne la sua appropriatezza. Risultati: 156 soggetti sono rientrati nei criteri proposti dalla Canadian C-Spine Rule (CCR) e nessuno ha riportato lesioni significative; se fosse stata applicata in ambito extra ospedaliero, la scala di valutazione sarebbe risultata sicura come verificato dalla successiva indagine radiologica. Conclusioni: I risultati di questo studio confermano quanto riportato dalla letteratura esistente. La Canadian C-Spine Rule (CCR) si conferma essere un valido strumento in grado di differenziare i pazienti traumatizzati che necessitano del collare cervicale in ambito extra ospedaliero o di ulteriori indagini diagnostiche in ambito ospedaliero. L’utilizzo della CCR richiede personale addestrato, migliora il comfort e può ridurre l’esecuzione di indagini diagnostiche. Parole chiave: Canadian C- Spine Rule (CCR), colonna cervicale; radiografia, trauma; lesione colonna cervicale, dipartimento d’emergenza

Riferimenti bibliografici

Sundstrøm T, Asbjørnsen H, Habiba S, Sunde GA, Wester K. Prehospital use of cervical collars in trauma patients: a critical review. J Neurotrauma. 2014 Mar 15;31(6):531-40. doi: 10.1089/neu.2013.3094.

Deasy C, Cameron P. Routine application of cervical collars--what is the evidence? Injury. 2011 Sep;42(9):841-2. doi: 10.1016/j.injury.2011.06.191.

Desai S, Liu C, Kirkland SW, Krebs LD, Keto-Lambert D, Rowe BH. Effectiveness of Implementing Evidence-based Interventions to Reduce C-spine Image Ordering in the Emergency Department: A Systematic Review. Acad Emerg Med. 2018 Jun;25(6):672-683. doi: 10.1111/acem.13364.

Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, Laupacis A, Schull M, McKnight RD, Verbeek R, Brison R, Cass D, Dreyer J, Eisenhauer MA, Greenberg GH, MacPhail I, Morrison L, Reardon M, Worthington J. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001 Oct 17;286(15):1841-8. doi: 10.1001/jama.286.15.1841.

Saragiotto BT, Michaleff ZA. The Canadian C-Spine Rule. J Physiother. 2016 Jul;62(3):170. doi: 10.1016/j.jphys.2016.04.001. Epub 2016 May 5. PMID: 27161303.

Michaleff ZA, Maher CG, Verhagen AP, Rebbeck T, Lin CW. Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review. CMAJ. 2012 Nov 6;184(16):E867-76. doi: 10.1503/cmaj.120675.

Hauswald M, Ong G, Tandberg D, Omar Z. Out-of-hospital spinal immobilization: its effect on neurologic injury. Acad Emerg Med. 1998 Mar;5(3):214-9. doi: 10.1111/j.1553-2712.1998.tb02615.x.

Stroh G, Braude D. Can an out-of-hospital cervical spine clearance protocol identify all patients with injuries? An argument for selective immobilization. Ann Emerg Med. 2001 Jun;37(6):609-15. doi: 10.1067/mem.2001.114409.

Kwan I, Bunn F, Roberts I. Spinal immobilisation for trauma patients. Cochrane Database Syst Rev. 2001;2001(2):CD002803. doi: 10.1002/14651858.CD002803.

Stiell IG, Clement CM, Lowe M, Sheehan C, Miller J, Armstrong S, Bailey B, Posselwhite K, Langlais J, Ruddy K, Thorne S, Armstrong A, Dain C, Perry JJ, Vaillancourt C. A Multicenter Program to Implement the Canadian C-Spine Rule by Emergency Department Triage Nurses. Ann Emerg Med. 2018 Oct;72(4):333-341. doi: 10.1016/j.annemergmed.2018.03.033.

Stiell IG, Clement CM, McKnight RD, Brison R, Schull MJ, Rowe BH, Worthington JR, Eisenhauer MA, Cass D, Greenberg G, MacPhail I, Dreyer J, Lee JS, Bandiera G, Reardon M, Holroyd B, Lesiuk H, Wells GA. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003 Dec 25;349(26):2510-8. doi: 10.1056/NEJMoa031375.

Coffey F, Hewitt S, Stiell I, Howarth N, Miller P, Clement C, Emberton P, Jabbar A. Validation of the Canadian c-spine rule in the UK emergency department setting. Emerg Med J. 2011 Oct;28(10):873-6. doi: 10.1136/emj.2009.089508.

Ngatchou W, Beirnaert J, Lemogoum D, Bouland C, Youatou P, Ramadan AS, Sontou R, Alima MB, Plumaker A, Guimfacq V, Bika C, Mols P. Application of the Canadian C-Spine rule and nexus low criteria and results of cervical spine radiography in emergency condition. Pan Afr Med J. 2018 Jun 21;30:157. doi: 10.11604/pamj.2018.30.157.13256.

Clement CM, Stiell IG, Lowe MA, Brehaut JC, Calder LA, Vaillancourt C, Perry JJ. Facilitators and barriers to application of the Canadian C-spine rule by emergency department triage nurses. Int Emerg Nurs. 2016 Jul;27:24-30. doi: 10.1016/j.ienj.2015.11.008.

Maschmann C, Jeppesen E, Rubin MA, Barfod C. New clinical guidelines on the spinal stabilisation of adult trauma patients - consensus and evidence based. Scand J Trauma Resusc Emerg Med. 2019 Aug 19;27(1):77. doi: 10.1186/s13049-019-0655-x.

Thorvaldsen NØ, Flingtorp LD, Wisborg T, Jeppesen E. Implementation of new guidelines in the prehospital services: a nationwide survey of Norway. Scand J Trauma Resusc Emerg Med. 2019 Aug 29;27(1):83. doi: 10.1186/s13049-019-0660-0.

Hawkins SC, Williams J, Bennett BL, Islas A, Kayser DW, Quinn R. Wilderness Medical Society Clinical Practice Guidelines for Spinal Cord Protection. Wilderness Environ Med. 2019 Dec;30(4S):S87-S99. doi: 10.1016/j.wem.2019.08.001.

Kornhall DK, Jørgensen JJ, Brommeland T, Hyldmo PK, Asbjørnsen H, Dolven T, Hansen T, Jeppesen E. The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury. Scand J Trauma Resusc Emerg Med. 2017 Jan 5;25(1):2. doi: 10.1186/s13049-016-0345-x.

McDonald NE, Curran-Sills G, Thomas RE. Outcomes and characteristics of non-immobilised, spine-injured trauma patients: a systematic review of prehospital selective immobilisation protocols. Emerg Med J. 2016 Oct;33(10):732-40. doi: 10.1136/emermed-2015-204693.

Connor D, Greaves I, Porter K, Bloch M; consensus group, Faculty of Pre-Hospital Care. Pre-hospital spinal immobilisation: an initial consensus statement. Emerg Med J. 2013 Dec;30(12):1067-9. doi: 10.1136/emermed-2013-203207.

Hood N, Considine J. Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature. Australas Emerg Nurs J. 2015 Aug;18(3):118-37. doi: 10.1016/j.aenj.2015.03.003.

Hauswald M, Braude D. Spinal immobilization in trauma patients: is it really necessary? Curr Opin Crit Care. 2002 Dec;8(6):566-70. doi: 10.1097/00075198-200212000-00014.

Maissan IM, Ketelaars R, Vlottes B, Hoeks SE, den Hartog D, Stolker RJ. Increase in intracranial pressure by application of a rigid cervical collar: a pilot study in healthy volunteers. Eur J Emerg Med. 2018 Dec;25(6):e24-e28. doi: 10.1097/MEJ.0000000000000490.

Ham W, Schoonhoven L, Schuurmans MJ, Leenen LP. Pressure ulcers from spinal immobilization in trauma patients: a systematic review. J Trauma Acute Care Surg. 2014 Apr;76(4):1131-41. doi: 10.1097/TA.0000000000000153.

Paxton M, Heal CF, Drobetz H. Adherence to Canadian C-Spine Rule in a regional hospital: a retrospective study of 406 cases. J Med Imaging Radiat Oncol. 2012 Oct;56(5):514-8. doi: 10.1111/j.1754-9485.2012.02430.x.

Refback

  • Non ci sono refbacks, per ora.