A new study published in The Spine Journal examines whether cervical spine clearance protocols in California are effective at trauma centers.
The researchers examined 15 Level I trauma centers, 30 Level II trauma centers and 11 Level III trauma centers in California. The researchers examined these four scenarios:
• Clearing the asymptomatic patient
• Initial imaging modality used for patients who are not amenable to clinical clearance
• Management strategies for patients with persistent neck pain who have a negative CT scan
• Patients who are obtunded
There was a 96 percent response rate. Here are five quick findings from the study:
1. There were 63 percent of the trauma centers that have cervical spine clearance protocols. The centers were broken down to:
• Level I: 93 percent
• Level II: 60 percent
• Level III: 27 percent
2. There were 83 percent of the Level I centers that used the National Emergency X-Radiography Utilization Study criteria with and without the painless range of motion for asymptomatic patients. The same is true for 61 percent of the Level II centers.
3. Among patients who require imaging, 67 percent of the Level I centers stated CT scans should be the first line of imaging. The same is true for 56 percent of the Level II centers.
4. There were more than 90 percent of the Level I centers that incorporated the 2009 EAST recommendations for obtunded patients and patients with persistent neck pain who also had a negative CT scan. The same was true for more than 70 percent of the Level II trauma centers.
5. There were no institutions that recommended passive flexion-extension radiographs among obtunded patients.
"Standardization and utilization of these protocols should be encouraged to prevent missed injuries and secondary neurologic injuries," concluded the study authors.