Management of patients with cervical spine trauma in the emergency department: a systematic critical appraisal of guidelines with a view to developing standardized strategies for clinical practice

Abstract

Several guidelines on the evaluation of patients with suspected cervical spine trauma in the Emergency Department (ED) exist. High heterogeneity between different guidelines has been reported. Aim of this study was to find areas of agreement and disagreement between guidelines, to identify topics in which further research is needed and to provide an evidence-based cervical spine trauma algorithm for ED physicians. The three most relevant guidelines published on cervical spine trauma in the last 10 years were selected screening websites of the main scientific societies and through the comparison of a normalized Google Scholar and SCOPUS citation index. We compared the selected guidelines through seven a-priori defined questions. In case of disagreement between the guidelines or if the quality of evidence appeared low, evidence from published systematic reviews on the topic was added to build an evidence-based algorithm for approach to spinal trauma in the ED. The three selected guidelines were: NICE 2016, Eastern Association for the Surgery of Trauma 2009 and American Association of Neurological Surgeons and Congress of Neurological Surgeons 2013. We found complete agreement on one question, partial agreement for one questions, no agreement for two questions, while agreement was not assessable for 3 questions. The agreement between different guidelines and the evidence on which recommendations are based is low. An attempt to build an evidence-based algorithm has been made. More studies are needed on many topics.

Quality evaluation of clinical practice guidelines for thromboprophylaxis in orthopaedic trauma based on AGREE II and AGREE-REX: a systematic review protocol

“…30 There is still no consensus on evaluating evidence and recommendations between different guidelines, which increases the uncertainty of clinical decision making. 31 Even in the relatively large number of hip fracture patients studied, physicians still believe that there is a lack of adequate clinical guidelines. 32 We hope to evaluate the relevant guidelines for VTE prevention in orthopaedic trauma and critically appraise the quality of the guidelines and recommendations.…”

“…Research in this field is scattered and controversial, and more work is needed to draw conclusions 30. There is still no consensus on evaluating evidence and recommendations between different guidelines, which increases the uncertainty of clinical decision making 31. Even in the relatively large number of hip fracture patients studied, physicians still believe that there is a lack of adequate clinical guidelines 32.…”

Practice Patterns and Management Protocols in Trauma across Indian Settings: A Nationwide Cross-sectional Survey

“…World Federation of Neurosurgical Societies (WFNS) Spine Committee and other guidelines recommend the use of special gear specifically based on the type and severity of the injury. 17 , 18 The majority of the centers were using a cervical collar (85%) and spine boards (63%) for in-house shifting of trauma patients, so there is a need to create awareness of when and in which type of trauma the cervical collar or spine boards should be used.…”