Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey

Martin, Matthew J.; Bush, Lisa D.; Inaba, Kenji; Byerly, Saskya; Schreiber, Martin; Peck, Kimberly A.; Barmparas, Galinos; Menaker, Jay; Hazelton, Joshua P.; Coimbra, Raúl; Zielinski, Martin D.; Brown, Carlos V R; Ball, Chad G.; Cherry-Bukowiec, Jill R.; Burlew, Clay Cothren; Dunn, Julie; Minshall, Christian T.; Carrick, Matthew M.; Berg, Gina M.; Δημητριάδης, Δημήτριος; Long, William B.

doi:10.1097/ta.0000000000001650

Cited by 33 publications

(38 citation statements)

References 51 publications

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“…We do also recommend that patients being affected by alcohol or drugs should be treated like all other non-intoxicated patients, since it is clinically difficult to differentiate between clinical findings resulting from intoxication or from other more critical injuries such as intracranial hemorrhage [61].…”

Section: Resultsmentioning

confidence: 99%

New clinical guidelines on the spinal stabilisation of adult trauma patients – consensus and evidence based

Maschmann

Jeppesen

Rubin

et al. 2019

Scand J Trauma Resusc Emerg Med

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Traumatic spinal cord injury is a relatively rare injury in Denmark but may result in serious neurological consequences. For decades, prehospital spinal stabilisation with a rigid cervical collar and a hard backboard has been considered to be the most appropriate procedure to prevent secondary spinal cord injuries during patient transportation. However, the procedure has been questioned in recent years, due to the lack of high-quality studies supporting its efficacy. A national interdisciplinary task force was therefore established to provide updated clinical guidelines on prehospital procedures for spinal stabilisation of adult trauma patients in Denmark. The guidelines are based on a systematic review of the literature and grading of the evidence, in addition to a standardised consensus process. This process yielded five main recommendations: A strong recommendation against spinal stabilisation of patients with isolated penetrating trauma; a weak recommendation against the prehospital use of a rigid cervical collar and a hard backboard for ABCDE-stable patients; and a weak recommendation for the use of a vacuum mattress for patient transportation. Finally, our group recommends the use of our clinical algorithm to ensure good clinical practice. Electronic supplementary material The online version of this article (10.1186/s13049-019-0655-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

New clinical guidelines on the spinal stabilisation of adult trauma patients – consensus and evidence based

Maschmann

Jeppesen

Rubin

et al. 2019

Scand J Trauma Resusc Emerg Med

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“…Other studies have investigated the utility of CT scan to allow clearance of the C-spine in obtunded non-intubated patients presenting to the Emergency Department (14,15). To the best of our knowledge this is the rst study in the literature to focus on the feasibility of CT scan-based cervical spine clearance in intubated trauma victims admitted to a Trauma Intensive Care Unit.…”

Section: Discussionmentioning

confidence: 99%

“…Two seminal articles published in 2016 and 2017 strongly supported the use of CT scan alone to exclude signi cant cervical spine injury in emergency department (ED) patients who failed NEXUS criteria; a prospective group of over 1600 alcohol-intoxicated patients, and a retrospective study of over 10 000 patients (14,15).…”

Section: Introductionmentioning

confidence: 99%

Cervical Spine Clearance on Trauma Intensive Care: Can We Trust a Negative CT Scan?

Hasandarras

Strandvik

Faramawy

et al. 2021

Preprint

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Background: Cervical spine clearance in intubated victims of blunt trauma remains contentious; accumulating high level evidence suggests that a normal CT cervical spine can be used to clear the c-spine and remove the collar in obtunded emergency department patients to prevent collar-related complications. However, it is unclear whether this holds true for intubated patients in the trauma intensive care unit (TICU).Methods: We performed a retrospective review of 730 intubated trauma patients who presented to the Level 1 Trauma center of a tertiary hospital. We reviewed the rate of missed cervical injuries in patients who had their cervical collars removed based on a normal computed tomography (CT) scan of the cervical spine, as well as rates of collar-related complications.Results: Three hundred and fifty patients had their cervical collars removed in the TICU based on the findings of a high-quality, well-interpreted normal CT cervical spine. Seventy percent of patients were intubated and sedated at the time of collar removal. Fifty-one percent of patients had concomitant traumatic brain injury. The average GCS at time of collar removal was 9. The incidence of missed neurological injury discerned clinically at time of both ICU and hospital discharge was nil (negative predictive value 100%). The rate of collar-related complications was 2%.Conclusion: Based on our findings, it is safe to remove the cervical collar for patients in the TICU following normal CT cervical spine, provided certain quality conditions related to the CT scan are met. Not removing the collar early may be related to increased complications. We provide an algorithm to assist critical-care clinicians in decision-making in this patient cohort

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“…Very few authors report falls as the most common mechanism of injury for CSI [ 6 ], with the majority reporting MVAs as the most common followed closely by falls [ 1 , 2 , 4 , 7 ]. We also noted the mean age for falls was 61.1 years which was higher than other causes of injury in our study.…”

Section: Discussionmentioning

confidence: 99%

“…There is a variation in incidence and epidemiological data of patients presenting with CSI in different populations [ 1 - 7 ]. The incidence of CSI ranges from 2% to 12%, with a higher incidence in those who are obtunded or intoxicated and patients who are difficult to evaluate clinically [ 1 - 4 ]. Most studies have reported a bimodal age distribution with the first peak between 15 years to 45 years and a second peak for those aged 65 years to 80 years [ 1 , 2 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and Characteristics of Cervical Spine Injury in Patients Presenting to a Regional Emergency Department

Umana

Khan

Baig

et al. 2018

Cureus

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PurposeThis study aims to establish the demographics and characteristics of patients with cervical spine injury (CSI) in an Irish cohort presenting to a regional emergency department.MethodsWe performed a retrospective analysis of the medical records of patients who underwent cervical spine computed tomography (CT) scans following trauma from January 2013 to July 2016. We looked at the mechanism of injury, mode of arrival to the emergency department, triage category, correlation between examination, and site of CSI and neurological status.ResultsOver the study period, 808 patients underwent CT scans of the cervical spine for potential CSI. The incidence of CSI in our cohort was 9.4% (n = 76). Approximately 70% (n = 53) were men. Falls (53%) and motor vehicle accidents (29%) were noted to be the more common mechanisms of injury in this cohort. The C2 region was the most common location for CSI. Only 7% (n = 5) of patients had documented neurology.ConclusionThis study demonstrates the epidemiology and characteristics of CSI presenting in an Irish cohort. The incidence of CSI was found to be 9.4% with a male preponderance and falls being the most common cause of trauma.

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Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey

Abstract: Diagnostic tests or criteria, level II.

Cited by 33 publications

References 51 publications

New clinical guidelines on the spinal stabilisation of adult trauma patients – consensus and evidence based

New clinical guidelines on the spinal stabilisation of adult trauma patients – consensus and evidence based

Cervical Spine Clearance on Trauma Intensive Care: Can We Trust a Negative CT Scan?

Epidemiology and Characteristics of Cervical Spine Injury in Patients Presenting to a Regional Emergency Department

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