Clearing the cervical spine in patients with distracting injuries: An AAST multi-institutional trial.
BACKGROUND: Single institution studies have shown that clinical examination of the cervical spine (c-spine) is sensitive for clearance of the c-spine in blunt trauma patients with distracting injuries. Despite an unclear definition, most trauma centers still adhere to the notion that distracting injuries adversely affect the sensitivity of c-spine clinical examination. A prospective AAST multi-institutional trial was performed to assess the sensitivity of clinical examination screening of the c-spine in awake and alert blunt trauma patients with distracting injuries.
METHODS: During the 42-month study period, blunt trauma patients 18 years and older were prospectively evaluated with a standard c-spine examination protocol at 8 Level 1 trauma centers. Clinical examination was performed regardless of the presence of distracting injuries. Patients without complaints of neck pain, tenderness or pain on range of motion were considered to have a negative c-spine clinical examination. All patients with positive or negative c-spine clinical examination underwent computed tomography (CT) scan of the entire c-spine. Clinical examination findings were documented prior to the CT scan.
RESULTS: During the study period, 2929 patients were entered. At least one distracting injury was diagnosed in 70% of the patients. A c-spine injury was found on CT scan in 7.6% of the patients. There was no difference in the rate of missed injury when comparing patients with a distracting injury to those without a distracting injury (10.4% vs. 12.6%, p = 0.601). Only one injury missed by clinical examination underwent surgical intervention and none had a neurological complication.
CONCLUSIONS: Negative clinical examination may be sufficient to clear the cervical spine in awake and alert blunt trauma patients, even in the presence of a distracting injury. These findings suggest a potential source for improvement in resource utilization.
LEVEL OF EVIDENCE: Therapeutic/care management, level IV.
J Trauma Acute Care Surg
Trauma; Cervical spine; C-spine
Khan, A. D., Liebscher, S. C., Reiser, H. C., Schroeppel, T. J., Anstadt, M. J., Bosarge, P. L., Carroll, S. L., Quick, J. A., Barnes, S. L., Sobrino, J., Murry, J., Morin, N., Gomez, M., Consani, H., Gonzalez, R. P. Clearing the cervical spine in patients with distracting injuries: An AAST multi-institutional trial. J Trauma Acute Care Surg 86, 28-35 (2019).