Journal Club: Clinical Prediction Rules
Editor's Capsule Summary for Vaillancourt et al1 What is already known on this topic
Previous out-of-hospital studies indicate that selective spinal immobilization may miss patients with cervical injury.
What question this study addressed
Can paramedics apply the Canadian C-Spine Rule in alert, stable, cooperative, blunt-trauma patients to reserve spinal immobilization for high-risk patients while avoiding immobilization for low-risk patients?
What this study adds to our knowledge
In this 1,949-patient cohort, paramedics achieved 100% sensitivity and 38% specificity for important cervical fractures.
How this might change clinical practice
Use of the Canadian C-spine Rule by paramedics may safely avoid unnecessary spinal immobilization.
Section editors: Tyler W. Barrett, MD; David L. Schriger, MD, MPH
Editor's Note: You are reading the twelfth installment of Annals of Emergency Medicine Journal Club. This bimonthly feature seeks to improve the critical appraisal skills of emergency physicians and other interested readers through a guided critique of actual Annals of Emergency Medicine articles. Each Journal Club will pose questions that encourage readers—be they clinicians, academics, residents, or medical students—to critically appraise the literature. During a 2- to 3-year cycle, we plan to ask questions that cover the main topics in research methodology and critical appraisal of the literature. To do this, we will select articles that use a variety of study designs and analytic techniques. These may or may not be the most clinically important articles in a specific issue, but they are articles that serve the mission of covering the clinical epidemiology curriculum.Journal Club entries are published in 2 phases. In the first phase, a list of questions about the article is published in the issue in which the article appears. Questions are rated “novice” (
), “intermediate” (
), and “advanced” (
) so that individuals planning a journal club can assign the right question to the right student. The answers to this journal club will be published in the April 2010 issue. US residency directors will have immediate access to the answers through the Council of Emergency Medicine Residency Directors Share Point Web site. International residency directors can gain access to the questions by going to http://www.emergencymedicine.ucla.edu/annalsjc/ and following the directions. Thus, if a program conducts its journal club within 5 months of the publication of the questions, no one will have access to the published answers except the residency director. The purpose of delaying the publication of the answers is to promote discussion and critical review of the literature by residents and medical students and discourage regurgitation of the published answers. It is our hope that the Journal Club will broaden Annals of Emergency Medicine's appeal to residents and medical students. We are interested in receiving feedback about this feature. Please e-mail journalclub@acep.org with your comments.
PII: S0196-0644(09)01553-4
doi:10.1016/j.annemergmed.2009.09.015
© 2009 Published by Elsevier Inc.
Refers to article:
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The Out-of-Hospital Validation of the Canadian C-Spine Rule by Paramedics
, 27 April 2009
