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Entwicklung eines neuen Protokolls zur präklinischen Immobilisation der Wirbelsäule bei Kindern und erste Anwendungsuntersuchung

Indikationsstellung anhand des E.M.S. IMMO Protocol Pediatric
  • Philip C. Nolte
  • Davut D. Uzun
  • Shiyao Liao
  • Matthias Kuch
  • Paul A. Grützner
  • Matthias Münzberg
  • Michael KreinestEmail author
Originalien

Zusammenfassung

Hintergrund

Um Sekundärschäden zu vermeiden, stellt die Immobilisation der potenziell verletzten Wirbelsäule eine Standardmaßnahme im präklinischen Traumamanagement dar. Immobilisationsprotokolle sollen dem notfallmedizinischen Fachpersonal helfen, richtige und schnelle Entscheidungen zu treffen. Die existierenden Protokolle für erwachsene Traumapatienten können nicht auf pädiatrische Patienten übertragen werden. Adäquate Protokolle für Kinder mit Wirbelsäulenverletzungen fehlen bisher.

Ziel der Arbeit

Ziele der Arbeit waren (i) die Entwicklung eines Protokolls zur Indikationsstellung der präklinischen Immobilisation der Wirbelsäule bei pädiatrischen Traumapatienten, welches auf der aktuellen wissenschaftlichen Literatur basiert, und (ii) die Analyse der Ergebnisqualität bei Anwendung des Protokolls durch notfallmedizinisches Fachpersonal.

Material und Methoden

Basierend auf einer strukturierten Literaturrecherche wurde eine neue Entscheidungshilfe zur präklinischen Immobilisation von pädiatrischen Traumapatienten entwickelt. Anschließend erfolgte anhand eines Fragebogens mit 4 Fallvignetten die Analyse der Ergebnisqualität bei der Anwendung des Protokolls. Hierzu musste für die 4 Fallvignetten die Indikation zur Immobilisation ohne und mit Verwendung des Protokolls gestellt werden.

Ergebnisse

Das E.M.S. IMMO Protocol Pediatric wurde auf Grundlage der bestehenden Literatur entwickelt. In der Untersuchung der Anwendbarkeit an 39 Studienteilnehmern (Notfallsanitäter, Notärzte etc.) zeigte sich, dass die Verwendung des E.M.S. IMMO Protocol Pediatric zu einer signifikant höheren Anzahl korrekter Indikationsstellungen führte. Insgesamt empfanden 38 Studienteilnehmer das Protokoll als hilfreich.

Diskussion

Auf der Grundlage der Literatur und unter Integration der gängigen Versorgungsstrategien von Traumapatienten wurde das E.M.S. IMMO Protocol Pediatric entwickelt. Die erste Anwendungsanalyse zeigt eine Verbesserung der Indikationsstellung.

Schlüsselwörter

Präklinisch Pädiatrisch Immobilisation Wirbelsäule Notfallmedizin 

Development and first application testing of a new protocol for preclinical spinal immobilization in children

Assessment of indications based on the E.M.S. IMMO Protocol Pediatric

Abstract

Background

To protect the spine from secondary damage, spinal immobilization is a standard procedure in prehospital trauma management. Immobilization protocols aim to support emergency medicine personnel in quick decision making but predominantly focus on the adult spine; however, trauma mechanisms and injury patterns in adults differ from those in children and applying adult prehospital immobilization protocols to pediatric patients may be insufficient. Adequate protocols for children with spinal injuries are currently unavailable.

Objective

The aim of this study was (i) to develop a protocol that supports decision making for prehospital spinal immobilization in pediatric trauma patients based on evidence from current scientific literature and (ii) to perform a first analysis of the quality of results if the protocol is used by emergency personnel.

Material and methods

Based on a structured literature search a new immobilization protocol was developed. Analysis of the quality of results was performed by a questionnaire containing four case scenarios in order to assess correct decision making. The decision about spinal immobilization was made without and with the utilization of the protocol.

Results

The E.M.S. IMMO Protocol Pediatric was developed based on the literature. The analysis of the quality of results was performed involving 39 emergency medicine providers. It could be shown that if the E.M.S. IMMO Protocol Pediatric was used, the correct type of immobilization was chosen more frequently. A total of 38 out of 39 participants evaluated the protocol as helpful.

Conclusion

The E.M.S. IMMO Protocol Pediatric provides decision-making support whether pediatric spine immobilization is indicated with respect to the cardiopulmonary status of the patient. In a first analysis, the E.M.S. IMMO Protocol Pediatric improves decision making by emergency medical care providers.

Keywords

Prehospital Pediatric Spine Immobilization Emergency medicine 

Notes

Danksagung

Wir bedanken uns bei Dr. Eva-Kristin Renker (EKR) und Prof. Dr. Dr. Peter Schmittenbecher (PS) für die eingebrachte Expertise und kritische Durchsicht des Protokolls.

Einhaltung ethischer Richtlinien

Interessenkonflikt

P.C. Nolte, D.D. Uzun, S. Liao, M. Kuch, P.A. Grützner, M. Münzberg und M. Kreinest geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • Philip C. Nolte
    • 1
  • Davut D. Uzun
    • 1
  • Shiyao Liao
    • 1
    • 2
  • Matthias Kuch
    • 3
  • Paul A. Grützner
    • 1
  • Matthias Münzberg
    • 1
  • Michael Kreinest
    • 1
    Email author
  1. 1.Klinik für Unfallchirurgie und OrthopädieBG Klinik LudwigshafenLudwigshafenDeutschland
  2. 2.Klinik für OrthopädieZhejiang Provincial People’s Hospital and People’s Hospital of Hangzhou Medical CollegeHangzhouVolksrepublik China
  3. 3.KindernotaufnahmeStädtisches Klinikum KarlsruheKarlsruheDeutschland

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