Spine Clearance Rules

[mikecwru]

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I'd like to invite you to participate in our multicenter prospective validation of our spine clearance rules, developed during my internship named the M+S Spine Clearnace rules for me/another chief at our program. They are much more simpler then either the NEXUS criteria or the Canadian rules.

If:

-there are greater than ten vertebral spaces tender
-the patient is less than a 35 year old female
-and she did not fall out of an airplane

There can be no clinically significant fracture. You need to stop all imaging, place her in a Miami J, and discharge her immediately.

If there are greater than 20 vertebrae tender, strongly consider fibromyalgia clinic (acute traumatic fibromyalgia is difficult to deal with).

Our calculations are that if ALL vertebral levels are tender, the chances of a clinisically sig fx are approx one in thirteen trillion.

My preliminary results show the rule (after about 100-150 observations) is 100% sensitive for any fracture, let alone clinically sig.

Discuss.

mike

 

[edinOH]

Down here we use the "Modified M+S Spine Clearance Rules" which take into account several additional factors along with those previously named.

-Did the patient check into the ED with three or more family members, all of which were riding in the same vehicle?

-Has the patient been witnessed to be eating either "Cheetos" brand snack or generic fried pork rinds obtained from the vending machine on the second floor or by the ED entrance while in the ED?

-Has the patient requested a work excuse or casually mentioned the words "disability", "That dude on T.V.", or "1-800 number"?

-Is the patient talking on a cell phone?

If the answer to any of the above is "yes", the patient can safely be discharged home with a script for naproxen, and a note for their employer stating the exact times the patient entered and exited the ED, down to the closest millisecond, and a release to work without restriction.

Our data has revealed these rules provide 110% reliability in the patient population sampled. I am unable to provide the exact sample size but based upon my own anecdotal experiences, that number, at least some nights, is probably near infinity (or at least equal to the population of north Baton Rouge).

(note the extra ten percent is not a typo. That is merely accounting for the few outlyers who actually had a fracture but were too stupid to know it...Doesn't make sense mathematically but I bet many of you know what I mean.)

 

[southerndoc]

Don't forget you can safely exclude any patient carrying the business card of a lawyer or who is flipping through the yellow pages when you walk into a room. (yes, I have witnessed that one before)

 

[DrQuinn]

I do, however, check a rectal on these patients. I would be remiss if I didn't find a high riding prostate or bogginess in the pouch of douglas that is secondary to their multiple near fractures. I am also sure to do the rectal exam even longer than normal, and am really sure to do a 360 degree exam. I also document well their movements and flexion/extension of their t/l spine during the exam.

I find this not only helps identify possible lower coccyx fractures, but also builds good rapport with the patient and their families.

Q

 

[Willamette]

but also builds good rapport with the patient and their families.

Q

Sweet...

Dude, that's funny!



Willamette

 

[southerndoc]

I do, however, check a rectal on these patients. I would be remiss if I didn't find a high riding prostate or bogginess in the pouch of douglas that is secondary to their multiple near fractures. I am also sure to do the rectal exam even longer than normal, and am really sure to do a 360 degree exam. I also document well their movements and flexion/extension of their t/l spine during the exam.

I find this not only helps identify possible lower coccyx fractures, but also builds good rapport with the patient and their families.

Q

Quinn, I heard that you're now advocating a three-finger salute for your rectal exams. Are you publishing your data for increased sensitivity and specificity?

 

[deleted6669]

no mechanism
why are you in c-spine dude
the medics were bored

 

[USCDiver]

"M+S criteria?" We call it the BS Criteria.

Another good reason to check a rectal is for good ole tone. Hate for that spinal compression to be missed in the otherwise neurologically intact patient with 6 months of low back pain who presents at 4am 'because they couldn't take it anymore' and 'tomorrow is monday morning'.

 

[Scrubbs]

In Philly, we have a phenomenon called SEPTAcemia. For those unfamiliar, it is a highly contagious form of chiselopathy caused by riding the bus (SEPTA). It generally leads to litigious behavior, and the request for purplecets and disability forms. Any patient suffering from SEPTAcemia cannot, under any circumstances, have a fracture or any other clinically significant problem, regardless of age. A therapeutic wait and rectal exam can be curative.

 

[GenSurg]

What do you do if you suspect that someone actually enjoys a little rectal exam?



http://www.freeiPods.com/?r=20049323

 

[edinOH]

What do you do if you suspect that someone actually enjoys a little rectal exam?



http://www.freeiPods.com/?r=20049323

Consult surgery.

 

[radswannabe]

Consult surgery.

boo you ruined my posts

 

[southerndoc]

Is the patient talking on a cell phone?

I used the edinOH C-spine clearance rules yesterday.