Performance Improvement (PI) Monitoring

POPULATION OF INTEREST

All patients at risk of or diagnosed with cervical or thoracic spine injury defined as:

- mechanism of injury explosion, fall, or motor vehicle crash;
- head or neck injury with AIS head or neck > 1;
- diagnosis of fracture of vertebral column with spinal cord injury (806), or spinal cord injury without evidence of spinal bone injury (952); and
- less than 1 day between time of injury and arrival at initial medical treatment facility (MTF).

INTENT (EXPECTED OUTCOMES)

1. Patients in population of interest have documented application of cervical collar or any other method for cervical spine stabilization in the prehospital setting or on MTF arrival.
2. Patients with diagnosis of fracture of vertebral column with spinal cord injury (806), or spinal cord injury without evidence of spinal bone injury (952) have a documented neurologic exam to include GCS and completed ASIA or Combat Neuro Exam worksheet.
3. Patients in population of interest have the C-spine clearance status documented on the JTS C-spine Clearance Status sheet and Resuscitation Record (DD Form 3019).
4. Patients with spinal cord injury and abnormal neurologic exam have an arterial line placed within 24 hours of injury or documentation that not indicated.
5. Patient in population of interest who have an unreliable exam due to decreased level of consciousness (GCS < 14) do not have C-spine cleared prior to arrival at definitive level of care.

PERFORMANCE/ADHERENCE METRICS

1. Number and percentage of patients in population of interest with documented application of cervical collar or any other method for cervical spine stabilization in the prehospital setting or on MTF arrival.
2. Number and percentage of patients with diagnosis of fracture of vertebral column with spinal cord injury (806), or spinal cord injury without evidence of spinal bone injury (952) with documented neurologic exam to include GCS completed ASIA or Combat Neuro Exam worksheet.
3. Number and percentage of patients in population of interest with C-spine clearance status documented on the C-spine Clearance Status sheet or the Resuscitation Record (DD Form 3019).
4. Number and percentage of patients with spinal cord injury and abnormal neurologic exam who have an arterial line placed within 24 hours of injury or documentation that not indicated.
5. Number and percentage of patients in population of interest with Role 2 and/or Role 3 discharge GCS < 14 who have a C-collar in place on arrival to Role 3 for host nation patients or Role 4 for coalition patients.

DATA SOURCE

- Patient Record and the ASIA or Combat Neuro Exam worksheet
- Department of Defense Trauma Registry (DoDTR)

SYSTEM REPORTING & FREQUENCY

The above constitutes the minimum criteria for PI monitoring of this CPG. System reporting will be performed annually; additional PI monitoring and system reporting may be performed as needed. The system review and data analysis will be performed by the JTS Chief and the PI Branch.