Table 1:
Spinal motion restriction (SMR) prevalence, techniques used, reasons for application and clinical suspicion for cervical spine injury (CSI) by participant age
| Age (years) | ||||||
|---|---|---|---|---|---|---|
| Overall (N = 7,721) |
0 – <2 (N = 927) |
2 – <8 (N = 2,304) |
8 – <16 (N = 3,711) |
≥16 (N = 779) |
P-value | |
| Spinal Motion Restriction (SMR) Prevalence 1 | ||||||
| SMR used during EMS transport | 3,206 (41.5%) | 204 (22.0%) | 819 (35.5%) | 1,790 (48.2%) | 393 (50.4%) | <.0016 |
| Full SMR2 | 1,137 (35.5%) | 30 (14.7%) | 266 (32.5%) | 703 (39.3%) | 138 (35.1%) | <.0016 |
| Cervical collar only | 1,689 (52.7%) | 54 (26.5%) | 429 (52.4%) | 977 (54.6%) | 229 (58.3%) | <.0016 |
| Rigid longboard or Vacuum mattress only | 162 (5.1%) | 35 (17.2%) | 50 (6.1%) | 65 (3.6%) | 12 (3.1%) | <.0016 |
| Towel only3 | 55 (1.7%) | 32 (15.7%) | 19 (2.3%) | 3 (0.2%) | 1 (0.3%) | <.0017 |
| Other | 163 (5.1%) | 53 (26.0%) | 55 (6.7%) | 42 (2.3%) | 13 (3.3%) | <.0016 |
| No SMR | 4,515 (58.5%) | 723 (78.0%) | 1,485 (64.5%) | 1,921 (51.8%) | 386 (49.6%) | <.0016 |
| Reasons for applying SMR 1 | ||||||
| Severe mechanism of injury | 1,900 (59.3%) | 127 (62.3%) | 528 (64.5%) | 1,027 (57.4%) | 218 (55.5%) | 0.0026 |
| Young age | 1,236 (38.6%) | 118 (57.8%) | 424 (51.8%) | 606 (33.9%) | 88 (22.4%) | <.0016 |
| Complaint of neck pain | 892 (27.8%) | 1 (0.5%) | 163 (19.9%) | 557 (31.1%) | 171 (43.5%) | <.0016 |
| Agency protocol | 746 (23.3%) | 49 (24.0%) | 189 (23.1%) | 415 (23.2%) | 93 (23.7%) | 0.9896 |
| Decreased mental status | 442 (13.8%) | 50 (24.5%) | 121 (14.8%) | 215 (12.0%) | 56 (14.2%) | <.0016 |
| Abnormal torso examination4 | 190 (5.9%) | 4 (2.0%) | 35 (4.3%) | 121 (6.8%) | 30 (7.6%) | 0.0036 |
| Distracting Injury | 151 (4.7%) | 1 (0.5%) | 47 (5.7%) | 93 (5.2%) | 10 (2.5%) | 0.0166 |
| Complaint of limited neck mobility | 150 (4.7%) | 0 (0.0%) | 12 (1.5%) | 112 (6.3%) | 26 (6.6%) | <.0016 |
| Placed by previous provider | 136 (4.2%) | 6 (2.9%) | 32 (3.9%) | 83 (4.6%) | 15 (3.8%) | 0.1646 |
| Abnormal head examination | 125 (3.9%) | 11 (5.4%) | 47 (5.7%) | 63 (3.5%) | 4 (1.0%) | 0.0266 |
| Focal neurologic deficit on examination | 92 (2.9%) | 5 (2.5%) | 19 (2.3%) | 52 (2.9%) | 16 (4.1%) | 0.3826 |
| Complaint of focal neurologic deficit | 66 (2.1%) | 0 (0.0%) | 5 (0.6%) | 41 (2.3%) | 20 (5.1%) | <.0016 |
| Abnormal neck examination | 63 (2.0%) | 2 (1.0%) | 13 (1.6%) | 37 (2.1%) | 11 (2.8%) | 0.3696 |
| Advised by medical direction | 46 (1.4%) | 4 (2.0%) | 10 (1.2%) | 24 (1.3%) | 8 (2.0%) | 0.6206 |
| Predisposing condition | 9 (0.3%) | 0 (0.0%) | 2 (0.2%) | 5 (0.3%) | 2 (0.5%) | 0.3746 |
| Unknown | 6 (0.2%) | 0 (0.0%) | 1 (0.1%) | 5 (0.3%) | 0 (0.0%) | 0.5886 |
| Other reason for SMR | 157 (4.9%) | 16 (7.8%) | 50 (6.1%) | 80 (4.5%) | 11 (2.8%) | 0.0136 |
| Clinical suspicion of CSI 5 | ||||||
| Clinical suspicion for presence of CSI | 0.0036 | |||||
| < 1% | 5,176 (67.0%) | 645 (69.6%) | 1,594 (69.2%) | 2,459 (66.3%) | 478 (61.4%) | |
| 1–5% | 1,430 (18.5%) | 169 (18.2%) | 386 (16.8%) | 706 (19.0%) | 169 (21.7%) | |
| 6–10% | 555 (7.2%) | 61 (6.6%) | 167 (7.2%) | 273 (7.4%) | 54 (6.9%) | |
| 11–50% | 406 (5.3%) | 36 (3.9%) | 120 (5.2%) | 196 (5.3%) | 54 (6.9%) | |
| > 50% | 154 (2.0%) | 16 (1.7%) | 37 (1.6%) | 77 (2.1%) | 24 (3.1%) | |
Percentages for specific types of SMR and reasons for applying SMR are out of those that had any SMR only.
Full SMR is defined as the application of cervical collar and rigid longboard or vacuum mattress.
Towel was defined by programmatically word searching for appropriate terms within the open text of ‘other specify’.
Abnormal torso examination indicates that the EMS clinician chose either: Abnormal chest examination, abnormal back examination, abnormal abdominal examination, or abnormal pelvic examination.
Clinical suspicion of CSI taken from the EMS provider form.
Pearson chi-square test of independence.
Fisher’s exact test of independence.