BACKGROUND: Cervical spine (CS) clearance in obtunded blunt trauma patients (OBTPs) remains controversial. When computed tomography (CT) of the CS is negative for injury, debate continues over the role of magnetic resonance imaging (MRI). Use of MRI in OBTPs is costly, time-consuming, and potentially dangerous. Our study evaluated the safety of a protocol to discontinue the cervical collar in OBTPs based on CT scan alone. METHODS: A prospective study was performed from October 2006 to September 2008 at a regional Level I trauma center on OBTPs with gross movement of all extremities. After a CT of the CS was read as negative for injury, the CS was cleared and the collar was removed. Patients were then followed prospectively for related complications. RESULTS: One hundred ninety-seven patients had their collars removed and CS cleared at a mean of 3.3 days. There were 144 males (73%), and the average age was 47.1 years. Sixty-two percent of patients were reexamined by a physician when no longer obtunded and found to have no CS signs or symptoms. Five patients (2.5%), when no longer obtunded, had persistent pain for which MRI CS was negative for injury. Coroner reports and autopsies were reviewed for missed spinal cord injuries in the 13% who died before reexamination. One of these patients had an autopsy report of an isolated CS ligamentous injury, deemed to be stable by our attending neurosurgeon. We followed up an additional 12% by phone or chart review, with no report of new onset neurologic deficit. The remaining 11% were lost to follow-up, but no patient contacted our hospital to report deterioration in function. One patient (0.5%) developed a minor CS decubitus ulceration. CONCLUSION: Removal of CS precautions in OBTPs with gross movement of all extremities is safe and efficacious if CT CS is negative for injury. Supplemental MRI CS is not needed in this patient population.
BACKGROUND: Cervical spine (CS) clearance in obtunded blunt traumapatients (OBTPs) remains controversial. When computed tomography (CT) of the CS is negative for injury, debate continues over the role of magnetic resonance imaging (MRI). Use of MRI in OBTPs is costly, time-consuming, and potentially dangerous. Our study evaluated the safety of a protocol to discontinue the cervical collar in OBTPs based on CT scan alone. METHODS: A prospective study was performed from October 2006 to September 2008 at a regional Level I trauma center on OBTPs with gross movement of all extremities. After a CT of the CS was read as negative for injury, the CS was cleared and the collar was removed. Patients were then followed prospectively for related complications. RESULTS: One hundred ninety-seven patients had their collars removed and CS cleared at a mean of 3.3 days. There were 144 males (73%), and the average age was 47.1 years. Sixty-two percent of patients were reexamined by a physician when no longer obtunded and found to have no CS signs or symptoms. Five patients (2.5%), when no longer obtunded, had persistent pain for which MRI CS was negative for injury. Coroner reports and autopsies were reviewed for missed spinal cord injuries in the 13% who died before reexamination. One of these patients had an autopsy report of an isolated CS ligamentous injury, deemed to be stable by our attending neurosurgeon. We followed up an additional 12% by phone or chart review, with no report of new onset neurologic deficit. The remaining 11% were lost to follow-up, but no patient contacted our hospital to report deterioration in function. One patient (0.5%) developed a minor CS decubitus ulceration. CONCLUSION: Removal of CS precautions in OBTPs with gross movement of all extremities is safe and efficacious if CT CS is negative for injury. Supplemental MRI CS is not needed in this patient population.
Authors: Kenji Inaba; Saskya Byerly; Lisa D Bush; Matthew J Martin; David T Martin; Kimberly A Peck; Galinos Barmparas; Matthew J Bradley; Joshua P Hazelton; Raul Coimbra; Asad J Choudhry; Carlos V R Brown; Chad G Ball; Jill R Cherry-Bukowiec; Clay Cothren Burlew; Bellal Joseph; Julie Dunn; Christian T Minshall; Matthew M Carrick; Gina M Berg; Demetrios Demetriades Journal: J Trauma Acute Care Surg Date: 2016-12 Impact factor: 3.313
Authors: Laura A Galganski; Jessica A Cox; David G Greenhalgh; Soman Sen; Kathleen S Romanowski; Tina L Palmieri Journal: J Burn Care Res Date: 2019-04-26 Impact factor: 1.845
Authors: Mayur B Patel; Stephen S Humble; Daniel C Cullinane; Matthew A Day; Randeep S Jawa; Clinton J Devin; Margaret S Delozier; Lou M Smith; Miya A Smith; Jeannette M Capella; Andrea M Long; Joseph S Cheng; Taylor C Leath; Yngve Falck-Ytter; Elliott R Haut; John J Como Journal: J Trauma Acute Care Surg Date: 2015-02 Impact factor: 3.313
Authors: Annelie Slaar; M M Fockens; Junfeng Wang; Mario Maas; David J Wilson; J Carel Goslings; Niels Wl Schep; Rick R van Rijn Journal: Cochrane Database Syst Rev Date: 2017-12-07
Authors: Iyore Ao James; Ahmad Moukalled; Elizabeth Yu; David B Tulman; Sergio D Bergese; Christian D Jones; Stanislaw Pa Stawicki; David C Evans Journal: J Emerg Trauma Shock Date: 2014-10