evaluated. We think that trauma units with access to a helical, multiplane, computed tomography scanner should routinely image the entire cervical spine at high resolution since the number needed to treat to detect a further injury beyond directed scanning may be only eight to 22 patients, 20 21 36 and this is the standard recommended in figure 2. This is similarly a level 2-3 recommendation; an urgent need remains for an adequately powered, prospective comparison of these modalities to justify any further recommendations. We propose the removal of cervical collars and patients' mobilisation as a priority for management. Therefore if plain radiographs and computed tomography imaging do not show evidence of traumatic abnormality and the patient is not expected to be conscious within 48-72 hours, current evidence supports the declaration "cervical spine cleared" without further delay. We draw attention to the routine inclusion of thoracolumbar plain radiography, where unconscious patients with multiple injuries have a compatible mechanism of injury. Contributors: CGM had the original idea, searched the literature, and wrote the main text. CGM and GGL managed the cases. EPM is guarantor. Funding: None.
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