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Table 4 Criteria PRO and CONTRA spinal immobilization taken from literature search and integration into the E.M.S. IMMO Protocol

From: Development of a new Emergency Medicine Spinal Immobilization Protocol for trauma patients and a test of applicability by German emergency care providers

PRO criteria References E.M.S. IMMO protocol
Age > 65 years [4, 21, 43] included in MARSHAL criteria
Rigid vertebral disease [52] not included as PRO criteria
State of acute anxiety [53] included in MARSHAL criteria (serious distraction)
Language barrier [53] included in assessment of impairment
Acute stress reaction [54] included in MARSHAL criteria (serious distraction)
Distracting injury [42, 44, 54] included in MARSHAL criteria (serious distraction)
Intoxication [52, 5456] included in assessment of impairment
Fall from > 6 m [57] included in MARSHAL criteria (fall from ≥ 2 m)
Fall from 3 to 6 m [57] included in MARSHAL criteria (fall from ≥ 2 m)
Fall from > 3 m [52, 58] included in MARSHAL criteria (fall from ≥ 2 m)
Fall from > 2 m [59] included in MARSHAL criteria (fall from ≥ 2 m)
Fall from > 1 m [38, 44] not included as PRO criteria
Fall from large animal [57] included in MARSHAL criteria (fall from ≥ 2 m)
High speed accident > 100 km/h [38, 44, 52] included in MARSHAL criteria
Speed > 56 km/h [58] not included as PRO criteria
MVA or pedestrian vs. train [57] included in MARSHAL criteria (locomotive or bike collision)
MVA ejection [38, 44, 57] included in MARSHAL criteria
Vehicle rollover [38, 44] included in MARSHAL criteria
Bicycle collision [38, 44] included in MARSHAL criteria
Road traffic collision [59] not included as PRO criteria
Significant intrusion of vehicle [44] not included as PRO criteria
Axial load to head [38, 44] included in MARSHAL criteria
Diving accident [52] included in MARSHAL criteria (axial load to head)
Sport injuries [59] not included as PRO criteria
Shooting [59] not included as PRO criteria
Death at scene [58, 60] not included as PRO criteria
Altered/loss of consciousness [5256, 61, 62] included in ABCDE criteria (unstable patient)
Spine pain/tenderness [4, 11, 20, 21, 24, 41, 49] included in MARSHAL criteria and in indication of spine injury
Abnormal sensory/motor exam [44, 45, 52, 55, 56, 62] included in MARSHAL criteria
Significant head or facial injury [52, 58, 61] included in MARSHAL criteria (supraclavicular injuries)
Other spine fractures [52] not included as PRO criteria
Supraclavicular lesions [45] included in MARSHAL criteria
Severe injuries to other body systems [52, 55, 56, 58, 61] not included as PRO criteria
CONTRA criteria References E.M.S. IMMO protocol
No neurological abnormalities [39, 50] included in MARSHAL criteria
No evidence of intoxication [39, 50, 63] included in assessment of impairment
No midline C-spine tenderness [39, 50] included in MARSHAL criteria
No distracting injury [39, 50, 63] included in assessment of impairment
Able to actively rotate neck [38, 44] included in indication of spine injury
Penetrating trauma [33] not included as CONTRA criteria
Functional range-of-motion [64] included in indication of spine injury