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60 CORRELATION OF THE PREHOSPITAL RPM TRIAGE SCORE WITH THE NEED FOR TRAUMA TEAM ACTIVATION AND TRAUMA PATIENT OUTCOME David John Schoenwetter, Douglas F. Kupas, Geisinger Medical Center Objective: The RPM triage score ranges from 0 to 12 and can be rapidly determined from patient respiratory rate, pulse rate, and motor score. The purpose of this study is to determine whether the prehospital RPM score correlates with traditional methods used to determine whether a trauma team should be activated before the arrival of a trauma patient and whether the RPM score correlates with patient mortality and need for emergent surgery. Methods: This retrospective study was performed at a Level 1 trauma center with accreditation for both adult and pediatric trauma patients. Data were obtained from an institutional trauma registry. Data analyzed included prehospital components of the RPM score [respiratory rate, heart rate, and motor score (from Glasgow Coma Score–motor component)], whether a trauma team was activated prior to patient arrival, patient mortality, and whether the patient required surgery. Results: 460 patients were included in the study. Of these patients, 299 (65%) were male, with a mean age of 39 (range 1–95). When comparing patients who had prehospital RPM £ 9 with those who had RPM greater than 9, respectively, activation of a trauma team occurred in 96% vs. 57% (p = 0.001), PPV 96% [95% CI 87–100]; death occurred in 25% vs. 3% (p = 0.001), NPV 97% [95% CI 94–98]; and surgery was required in 27% vs. 27% (p = 0.47). Conclusion: In this retrospective study, a prehospital RPM score £ 9 strongly correlated with activation of a trauma team and a prehospital RPM score >9 strongly correlated with patient survival. 61 EFFECT OF AGE AND MECHANISM OF INJURY ON PREHOSPITAL CLINICAL SPINE CLEARANCE Rahul Khare, Robert M. Dome- ier, Shirley M. Frederiksen, Kathy Welch, University of Michigan/Saint Joseph Mercy Hospital Emergency Medicine Residency Objective: It has been suggested that elderly patients and those with significant mechanisms of injury may not be appropriate candidates for clinical spine assessment and clearance. The purpose of this study is to determine the effect of elderly age or mechanism of injury on the performance of prehospital clinical spine clearance criteria. Methods: Design: Multicenter prospective cohort. EMS personnel documented a spine injury assessment for trauma patients using a check- off data box on the EMS run sheet. All trauma runs were collected from October 1997 through September 2001. Age, mechanism of injury, and elements of the clinical injury assessment were abstracted from the EMS records. Outcome data from hospital records included spine injury and treatment. The data set was divided based on odds ratios for defined mechanisms of injury into high- and low-risk groups, and separately for patients aged more than 64. Results: Data were collected on 13,557 patients. There were 415 (3.1%) patients with spine injuries identified. There were 2,658 patients with age greater than 64 years. There were 83 (3.1%) injuries in this group. Clinical criteria identified 66 of 83 (79.5%) in this group compared with 312 of 332 (94%) for the rest of the population (p , 0.001). There were 310 patients with 86 (24%) injuries in the high-risk mechanism group, and 12,997 patients with 329 (2.5%) injuries in the low-risk mechanism group. Clinical criteria identified 83 of 86 (96.5%) injuries in the high-risk group and 295 of 329 (89.7%) in the low-risk group (p = 0.047). Conclusion: Clinical criteria performed better for high-risk mechanism patients and not as well in patients with age greater than 64 years. No patient for whom there was a missed injury had an adverse outcome as a result. Prehospital clinical criteria may be used safely in patients with high-risk mechanisms as well as in the elderly. 62 PATIENT DISCOMFORT DUE TO INDISCRIMINANT USE OF SPINAL IMMOBILIZATION George R. Zlupko, Ross E. Megargel, Robert E. O’Connor, Christiana Care Health System Objective: The purpose of this study was to measure the level of discomfort (using a visual analog pain scale (VAS) associated with the use of spinal immobilization using long board and collar. A secondary goal of the study was to measure the concordance between emergency physician (EP) and BLS personnel in conducting a brief neurological screening exam. Methods: We performed this prospective study in the emergency department of a Level-I trauma center. Patients who could be clinically cleared from spinal immobilization were eligible (i.e., no loss of consciousness, distracting injury, or spinal tenderness). After obtaining informed consent, a baseline VAS was obtained. A mini- neurological exam was conducted by BLS personnel and by the EP. Exam elements consisted of assessment of mental status (awake, alert, oriented), speech, and extremity motor and sensory exam. The EP and BLS then removed spinal immobilization, and the exam and VAS assessment were repeated immediately. The kappa statistic was used to measure inter-rater reliability of exam, and pre- and post- VAS scores were compared using the Mann-Whitney U test. Results: A total of 26 patients were enrolled in the study. The mean VAS while on the long board was 53 mm. The mean VAS after removal was 26 mm, for a mean reduction of 27 mm (p = 0.0007). One patient showed no change in VAS, and 20 of 26 (77%) experienced a reduction in VAS of at least 13 mm. No patients described an increase in VAS, and two patients described paresthesias with deboarding. Concordance be- tween the BLS and EP neurological exams was 100%. Conclusion: Removal of spinal immobilization results in reduction of discomfort, as measured by the VAS. Neurological exam can be performed with a high degree of agreement between BLS providers and EPs. 63 COMPARISON OF TRADITIONAL BACKBOARD AND VACUUM SPLINT MATTRESS IMMOBILIZATION IN THE ELDERLY Steve O. Holsenback, David Peter, Rita Chambers, Carolyn J. Williams, Les Gaiser, Ellis Polk, Akron General Medical Center Objective: Elderly patients frequently require immobilization during EMS transport. Multiple co-morbidities, pronounced thoracic kyphosis, decreased subcutaneous fat, and multiple other conditions make it difficult to immobilize these patients without significant discomfort on traditional backboards. The purpose of this study was to compare the perceptions of pain 101 NAEMSP ANNUAL MEETING ABSTRACTS
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60 CORRELATION OF THE PREHOSPITAL RPM TRIAGE SCORE WITH
THE NEED FOR TRAUMA TEAM ACTIVATION AND TRAUMA PATIENT
OUTCOME David John Schoenwetter, Douglas F. Kupas,Geisinger Medical Center
Objective: The RPM triage score ranges from 0 to 12 and canbe rapidly determined from patient respiratory rate, pulserate, and motor score. The purpose of this study is todetermine whether the prehospital RPM score correlates withtraditional methods used to determine whether a traumateam should be activated before the arrival of a traumapatient and whether the RPM score correlates with patientmortality and need for emergent surgery. Methods: Thisretrospective study was performed at a Level 1 trauma centerwith accreditation for both adult and pediatric traumapatients. Data were obtained from an institutional traumaregistry. Data analyzed included prehospital components ofthe RPM score [respiratory rate, heart rate, and motor score(from Glasgow Coma Score–motor component)], whethera trauma team was activated prior to patient arrival, patientmortality, and whether the patient required surgery. Results:460 patients were included in the study. Of these patients, 299(65%) were male, with a mean age of 39 (range 1–95). Whencomparing patients who had prehospital RPM £ 9 with thosewho had RPM greater than 9, respectively, activation ofa trauma team occurred in 96% vs. 57% (p = 0.001), PPV 96%[95% CI 87–100]; death occurred in 25% vs. 3% (p = 0.001),NPV 97% [95% CI 94–98]; and surgery was required in 27%vs. 27% (p = 0.47). Conclusion: In this retrospective study,a prehospital RPM score £ 9 strongly correlated withactivation of a trauma team and a prehospital RPM score>9 strongly correlated with patient survival.
61 EFFECT OF AGE AND MECHANISM OF INJURY ON PREHOSPITAL
CLINICAL SPINE CLEARANCE Rahul Khare, Robert M. Dome-ier, Shirley M. Frederiksen, Kathy Welch, University ofMichigan/Saint Joseph Mercy Hospital Emergency MedicineResidency
Objective: It has been suggested that elderly patients andthose with significant mechanisms of injury may not beappropriate candidates for clinical spine assessment andclearance. The purpose of this study is to determine the effectof elderly age or mechanism of injury on the performance ofprehospital clinical spine clearance criteria. Methods: Design:Multicenter prospective cohort. EMS personnel documenteda spine injury assessment for trauma patients using a check-off data box on the EMS run sheet. All trauma runs werecollected from October 1997 through September 2001. Age,mechanism of injury, and elements of the clinical injuryassessment were abstracted from the EMS records. Outcomedata from hospital records included spine injury andtreatment. The data set was divided based on odds ratiosfor defined mechanisms of injury into high- and low-riskgroups, and separately for patients aged more than 64.Results: Data were collected on 13,557 patients. There were415 (3.1%) patients with spine injuries identified. There were2,658 patients with age greater than 64 years. There were 83(3.1%) injuries in this group. Clinical criteria identified 66 of83 (79.5%) in this group compared with 312 of 332 (94%) forthe rest of the population (p, 0.001). There were 310 patients
with 86 (24%) injuries in the high-risk mechanism group, and12,997 patients with 329 (2.5%) injuries in the low-riskmechanism group. Clinical criteria identified 83 of 86(96.5%) injuries in the high-risk group and 295 of 329(89.7%) in the low-risk group (p = 0.047). Conclusion:Clinical criteria performed better for high-risk mechanismpatients and not as well in patients with age greater than 64years. No patient for whom there was a missed injury had anadverse outcome as a result. Prehospital clinical criteria maybe used safely in patients with high-risk mechanisms as wellas in the elderly.
101NAEMSP ANNUAL MEETING ABSTRACTS
62 PATIENT DISCOMFORT DUE TO INDISCRIMINANT USE OF SPINAL
IMMOBILIZATION George R. Zlupko, Ross E. Megargel,Robert E. O’Connor, Christiana Care Health System
Objective: The purpose of this study was to measure the levelof discomfort (using a visual analog pain scale (VAS)associated with the use of spinal immobilization using longboard and collar. A secondary goal of the study was tomeasure the concordance between emergency physician (EP)and BLS personnel in conducting a brief neurologicalscreening exam. Methods: We performed this prospectivestudy in the emergency department of a Level-I traumacenter. Patients who could be clinically cleared from spinalimmobilization were eligible (i.e., no loss of consciousness,distracting injury, or spinal tenderness). After obtaininginformed consent, a baseline VAS was obtained. A mini-neurological exam was conducted by BLS personnel and bythe EP. Exam elements consisted of assessment of mentalstatus (awake, alert, oriented), speech, and extremity motorand sensory exam. The EP and BLS then removed spinalimmobilization, and the exam and VAS assessment wererepeated immediately. The kappa statistic was used tomeasure inter-rater reliability of exam, and pre- and post-VAS scores were compared using the Mann-Whitney U test.Results: A total of 26 patients were enrolled in the study. Themean VAS while on the long board was 53 mm. The meanVAS after removal was 26 mm, for a mean reduction of 27 mm(p = 0.0007). One patient showed no change in VAS, and 20 of26 (77%) experienced a reduction in VAS of at least 13 mm. Nopatients described an increase in VAS, and two patientsdescribed paresthesias with deboarding. Concordance be-tween the BLS and EP neurological exams was 100%.Conclusion: Removal of spinal immobilization results inreduction of discomfort, as measured by the VAS.Neurological exam can be performed with a high degree ofagreement between BLS providers and EPs.
63 COMPARISON OF TRADITIONAL BACKBOARD AND VACUUM
SPLINT MATTRESS IMMOBILIZATION IN THE ELDERLY Steve O.Holsenback, David Peter, Rita Chambers, Carolyn J.Williams, Les Gaiser, Ellis Polk, Akron General MedicalCenter
Objective: Elderly patients frequently require immobilizationduring EMS transport. Multiple co-morbidities, pronouncedthoracic kyphosis, decreased subcutaneous fat, and multipleother conditions make it difficult to immobilize these patientswithout significant discomfort on traditional backboards. Thepurpose of this study was to compare the perceptions of pain
