Evaluation of the Nursing C-Spine (Phase IV) - Full Text View

Purpose

Neck injuries are a common problem among blunt trauma victims with more than 8,000,000 cases being seen annually in U.S. and Canadian EDs. While the majority of these cases represent soft tissue injuries, 30,000 patients suffer cervical spine fractures or dislocations and approximately 10,000 suffer spinal cord injury. There are no readily available national Canadian data on ED visits such as those provided by the U.S. National Hospital Ambulatory Medical Care Survey. The prevalence of potential neck injury can, however, be reasonably estimated for Canadian EDs. Extrapolation, on a population basis, from reliable U.S. figures suggests that 1.3 million potential neck injury patients are seen annually in Canada. Only 0.9% of these patients are found to have cervical spine fractures or dislocations.

Condition	Intervention	Phase
Fracture of Cervical Spine Fracture Dislocation of Cervical Spine	Other: Clinical decision rule - clearing the c-spine	Phase 4

Study Type:	Interventional
Study Design:	Allocation: Non-Randomized Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	Evaluation of the Safety of C-Spine Clearance by Emergency Department Triage Nurses (Phase IV)

Resource links provided by NLM:

MedlinePlus related topics: Dislocations Fractures Injuries Neck Injuries and Disorders Shoulder Injuries and Disorders Wounds

U.S. FDA Resources

Further study details as provided by Ottawa Hospital Research Institute:

Primary Outcome Measures:

Determine safety: Number of missed CSI & Number of serious adverse outcomes Determine clinical impact: C-spine clearance rates by nurses & Lengths of time [ Time Frame: Dec 2010 ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:

Evaluate performance: Accuracy of the rule, Nurse accuracy in overall interpretation of the rule & Nurse comfort with and use of the rule. [ Time Frame: Dec 2010 ] [ Designated as safety issue: No ]
Evaluate performance [ Time Frame: December 2010 ] [ Designated as safety issue: No ]
Evaluate performance: Accuracy of the rule, Nurse accuracy in overall interpretation of the rule & Nurse comfort with and use of the rule.

Enrollment:	3633
Study Start Date:	January 2008
Study Completion Date:	August 2010
Primary Completion Date:	July 2010 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Cervical spine injury We enrolled consecutive alert adults who were in stable condition and who presented with potential cervical spine injury after acute blunt trauma, including patients with posterior neck pain and those presenting by ambulance with immobilization of the cervical spine.	Other: Clinical decision rule - clearing the c-spine The goal of phase IV of the Canadian C-Spine Rule project is to evaluate the safety and potential impact of an active strategy to empower ED triage nurses to evaluate and clear the c-spine of very low-risk trauma patients.

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Eligibility

Ages Eligible for Study:	16 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	Yes

Criteria

Inclusion Criteria:

The investigators will enroll consecutive alert, stable adults presenting to the study hospital EDs with potential c-spine injury after sustaining acute blunt trauma. These will be patients presenting with neck pain or with c-spine immobilization on an ambulance stretcher. Patient eligibility will be determined based on these criteria at the time of arrival in the ED.

"Potential c-spine injury after sustaining acute blunt trauma" will include patients with either: i) neck pain with any mechanism of injury (subjective complaint by the patient of any pain in the posterior aspect of the neck), and/or ii) presentation by ambulance with c-spine immobilization after injury (typically backboard and collar).
"Alert" is defined as a Glasgow Coma Scale103 score of 15 (converses, fully oriented, and follows commands).
"Stable" refers to normal vital signs as defined by the Revised Trauma Score31 (systolic blood pressure 90 mm Hg or greater and respiratory rate between 10 and 24 breaths per minute).
"Acute" refers to injury within the past 48 hours.

Exclusion Criteria:

Patients under the age of 16 years,
Patients who do not satisfy the definition of "potential c-spine injury" as defined above (for example, patients with neither neck pain nor arriving with ambulance c-spine immobilization will be excluded),
Patients with Glasgow Coma Scale score less than 15,
Patients with unstable vital signs (systolic BP < 90; respiratory rate less than 10 or more than 24),
Patients whose injury occurred more than 48 hours previously,
Patients with penetrating trauma from stabbing or gunshot wound,
Patients with acute paralysis (paraplegia, quadriplegia),
Patients with known vertebral disease (ankylosing spondylitis, rheumatoid arthritis, spinal stenosis, or previous cervical spine surgery),
Patients who return for reassessment of the same injury, or
Patients referred from another hospital.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01353352

Locations

Canada, Ontario
The Ottawa Hospital
Ottawa, Ontario, Canada, K1Y 4E9

Sponsors and Collaborators

Ottawa Hospital Research Institute

Canadian Institutes of Health Research (CIHR)

Investigators

Principal Investigator:

Ian G Stiell, MD

Ottawa Hospital Research Institute

More Information

No publications provided

Responsible Party:	Dr Ian Stiell, Principal Investigator, Ottawa Hospital Research Institutute & University of Ottawa
ClinicalTrials.gov Identifier:	NCT01353352 History of Changes
Other Study ID Numbers:	MOP-86709, 2007542-01H
Study First Received:	October 13, 2010
Last Updated:	May 12, 2011
Health Authority:	Canada: Ethics Review Committee

Keywords provided by Ottawa Hospital Research Institute:

Evaluation
C-Spine
Nursing
Clinical Decision Rule

Additional relevant MeSH terms:

Dislocations
Fractures, Bone
Wounds and Injuries

ClinicalTrials.gov processed this record on May 19, 2013