Cervical Spine Clearance in the Obtunded Patient
- Evaluation of Cervical Spine Clearance by Computed Tomographic Scan Alone in Intoxicated Patients With Blunt Trauma.
- Bush L, Brookshire R, Roche B, Johnson A, Cole F, Karmy-Jones R, Long W, Martin MJ.
- JAMA Surg. 2016 Sep 1;151(9):807-13.
Rationale for inclusion: Prospective, observational study of 1668 intoxicated patients who underwent cervical spine CTs. CT alone had a 99.8% negative predictive value for ruling out injury requiring immobilization or stabalization.
Citations - 1 (as of July 2017)
- Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma.
- Patel MB, Humble SS, Cullinane DC, Day MA, Jawa RS, Devin CJ, Delozier MS, Smith LM, Smith MA, Capella JM, Long AM, Cheng JS, Leath TC, Falck-Ytter Y, Haut ER, Como JJ.
- J Trauma Acute Care Surg. 2015 Feb;78(2):430-41.
Rationale for inclusion: EAST Practice Management Guideline recommended the conditional removal of cervical collars in obtunded patients after negative, high-quality CT scans.
Citations - 32 (as of July 2017)
- MRI is unnecessary to clear the cervical spine in obtunded/comatose trauma patients: The four-year experience of a level I trauma center
- Tomycz ND, Chew BG, Chang YF, Darby JM, Gunn SR, Nicholas DH, Ochoa JB, Peitzman AB, Schwartz E, Pape HC, Spiro RM, Okonkwo DO.
- J Trauma. 2008 May;64(5):1258-63.
Rationale for inclusion: Retrospective series of 690 patients who underwent CT and MRI with 38 new acute findings on MRI, none of which were unstable or required surgery.
Citations - 86 (as of July 2017)
- Is magnetic resonance imaging essential in clearing the cervical spine in obtunded patients with blunt trauma?
- Como JJ, Thompson MA, Anderson JS, Shah RR, Claridge JA, Yowler CJ, Malangoni MA.
- J Trauma. 2007 Sep;63(3):544-9.
Rationale for inclusion: A prospective evaluation of obtunded patients who underwent both CT and MRI detected 6 new injuries with MRI--none of which changed clinical management.
Citations - 102 (as of July 2017)
- Magnetic resonance imaging in combination with helical computed tomography provides a safe and efficient method of cervical spine clearance in the obtunded trauma patient.
- Stassen NA, Williams VA, Gestring ML, Cheng JD, Bankey PE.
- J Trauma. 2006 Jan;60(1):171-7.
Rationale for inclusion: Obtunded patients who underwent both CT and MRI were reviewed. 30% had ligamentous injury of MRI not detected on CT.
Citations - 84 (as of July 2017)
- Clearing the cervical spine in obtunded patients: the use of dynamic fluoroscopy.
- Davis JW, Parks SN, Detlefs CL, Williams GG, Williams JL, Smith RW.
- J Trauma. 1995 Sep;39(3):435-8.
Rationale for inclusion: A now historical technique of clearing cervical collars in obtunded patients that has been abandoned due to the now widespread use of CT scan and/or MRI
Citations - 136 (as of July 2017)