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Evaluating the paramedic application of the prehospital Canadian C-Spine Rule in sport-related injuries

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Canadian Journal of Emergency Medicine Aims and scope Submit manuscript

Abstract

Objectives

We sought to compare the ability of the prehospital Canadian C-Spine Rule to selectively recommend immobilization in sport-related versus non-sport-related injuries and describe sport-related mechanisms of injury.

Methods

We reviewed data from the prospective paramedic Canadian C-Spine Rule validation and implementation studies in 7 Canadian cities. A trained reviewer further categorized sport-related mechanisms of injury collaboratively with a sport medicine physician using a pilot-tested standardized form. We compared the Canadian C-Spine Rule’s recommendation to immobilize sport-related versus non-sport-related patients using Chi-square and relative risk statistics with 95% confidence intervals.

Results

There were 201 sport-related patients among the 5,978 included. Sport-related injured patients were younger (mean age 36.2 vs. 42.4) and more predominantly male (60.5% vs. 46.8%) than non-sport-related patients. Paramedics did not miss any C-Spine injury when using the Canadian C-Spine Rule. C-Spine injury rates were similar between sport (2/201; 1.0%) and non-sport-injured patients (47/5,777; 0.8%). The Canadian C-Spine Rule recommended immobilization equally between groups (46.4% vs. 42.5%; RR 1.09 95%CI 0.93–1.28), most commonly resulting from a dangerous mechanism among sport-injured (68.7% vs. 54.5%; RR 1.26 95%CI 1.08–1.47). The most common dangerous mechanism responsible for immobilization in sport was axial load.

Conclusion

Although equal proportions of sport and non-sport-related injuries were immobilized, a dangerous mechanism was most often responsible for immobilization in sport-related cases. These findings do not address the potential impact of using the Canadian C-Spine Rule to evaluate collegiate or pro athletes assessed by sport medicine physicians. It does support using the Canadian C-Spine Rule as a tool in sport-injured patients assessed by paramedics.

Résumé

Objectifs

Nous avons cherché à comparer la capacité préhospitalière de la Canadian C-spine Rule à recommander de façon sélective l’immobilisation dans les blessures liées au sport par rapport aux blessures non liées au sport et à décrire les mécanismes des blessures liés au sport.

Les méthodes

Nous avons examiné les données des études prospectives de validation et de mise en œuvre de la règle canadienne de la colonne vertébrale dans sept villes canadiennes. Un examinateur qualifié a ensuite classé les mécanismes de blessure liés au sport, en collaboration avec un médecin du sport, à l'aide d'un formulaire standardisé testé dans le cadre d'un projet pilote. Nous avons comparé la recommandation de la Canadian C-Spine Rule d'immobiliser les patients liés au sport par rapport aux patients non liés au sport en utilisant les statistiques du chi carré et du risque relatif avec un intervalle de confiance de 95 %.

Résultats

Parmi les 5 978 patients inclus il y avait 201 patients liés au sport. Les patients blessés liés au sport étaient plus jeunes (âge moyen 36,2 ans contre 42,4 ans) et plus majoritairement de sexe masculin (60,5 % contre 46,8 %) que les patients non liés au sport. Les ambulanciers paramédicaux n’ont manqué aucune blessure au rachis cervical lorsqu’ils ont utilisé la Canadian C-spine Rule. Les taux de blessures au rachis cervical étaient semblables chez les patients sportifs (2/201 ; 1,0 %) et non sportifs (47/5 777 ; 0,8 %). La Canadian C-spine Rule recommande l'immobilisation de manière égale entre les groupes (46,4 % contre 42,5 % ; RR 1,09 95 % IC 0,93-1,28), le plus souvent en raison d'un mécanisme dangereux chez les sportifs blessés (68,7 % contre 54,5 % ; RR 1,26 95 % IC 1,08-1,47). Le mécanisme dangereux le plus souvent responsable de l'immobilisation dans le sport était la charge axiale.

Conclusion

Bien que des proportions égales de blessures sportives et non sportives aient été immobilisées, un mécanisme dangereux était le plus souvent responsable de l'immobilisation dans les cas liés au sport. Ces conclusions n'abordent pas l'impact potentiel de l'utilisation de la Canadian C-spine Rule pour évaluer les athlètes collégiaux ou professionnels évalués par les médecins du sport. Elle est favorable à l'utilisation de la Canadian C-spine Rule comme outil pour les patients blessés par le sport et évalués par les ambulanciers.

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Author information

Authors and Affiliations

  1. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada

    Harrison Carmichael

  2. Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada

    Christian Vaillancourt & Ian G. Stiell

  3. Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada

    Ian Shrier

  4. Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Manya Charette

  5. University of Ottawa, Ottawa, ON, Canada

    Elisabeth Hobden

  6. Ottawa Hospital, Civic Campus, 1053 Carling Ave., Ottawa, ON, K1Y 4E9, Canada

    Harrison Carmichael

Authors
  1. Harrison Carmichael
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  2. Christian Vaillancourt
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  3. Ian Shrier
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  4. Manya Charette
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  5. Elisabeth Hobden
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  6. Ian G. Stiell
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Correspondence to Harrison Carmichael.

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Carmichael, H., Vaillancourt, C., Shrier, I. et al. Evaluating the paramedic application of the prehospital Canadian C-Spine Rule in sport-related injuries. Can J Emerg Med 23, 356–364 (2021). https://doi.org/10.1007/s43678-021-00086-y

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  • DOI: https://doi.org/10.1007/s43678-021-00086-y

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