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Cervical Spine Clearance

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Cervical spinal clearance: A prospective Western Trauma Association Multi-institutional Trial.
Inaba K, Byerly S, Bush LD, Martin MJ, Martin DT, Peck KA, Barmparas G, Bradley MJ, Hazelton JP, Coimbra R, Choudhry AJ, Brown CV, Ball CG, Cherry-Bukowiec JR, Burlew CC, Joseph B, Dunn J, Minshall CT, Carrick MM, Berg GM, Demetriades D; WTA C-Spine Study Group.
J Trauma Acute Care Surg. 2016 Dec;81(6):1122-1130.

Rationale for inclusion: Prospective, observational study of 10,765 patients requiring acute imaging for their C-spine after blunt trauma.  CT was effective for ruling out clinically significant injury with 98.5% sensitivity.

Citations - 1 (as of July 2017)

Unstable cervical spine fracture after penetrating neck injury: a rare entity in an analysis of 1,069 patients.
Lustenberger T, Talving P, Lam L, Kobayashi L, Inaba K, Plurad D, Branco BC, Demetriades D.
J Trauma. 2011 Apr;70(4):870-2.

Rationale for inclusion:  Large series from LA examining the role of cervical collars after penetrating neck injuries.  The incidence of unstable C-spine injury was 0.4% and all resulted from GSWs with coma or focal neurologic deficits.

Citations - 45 (as of July 2017)

Magnetic resonance imaging (MRI) in the clearance of the cervical spine in blunt trauma: a meta-analysis.
Muchow RD, Resnick DK, Abdel MP, Munoz A, Anderson PA.
J Trauma. 2008 Jan;64(1):179-89.

Rationale for inclusion: Meta-analysis included 464 patients who underwent MRI along with either plain radiographs or CT scan of the cervical spine and found 20% had injuries detected on MRI that were not detected on plain films or MRI.

Citations - 106 (as of July 2017)

Prospective evaluation of multislice computed tomography versus plain radiographic cervical spine clearance in trauma patients.
Mathen R, Inaba K, Munera F, Teixeira PG, Rivas L, McKenney M, Lopez P, Ledezma CJ.
J Trauma. 2007 Jun;62(6):1427-31.

Rationale for inclusion: Prospective study of 667 patients who underwent 3 view plain radiographs and CT scan of the cervical spine.  CT was deemed superior as plain films missed 55% of clinically significant fractures.

Citations - 88 (as of July 2017)

The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma.
Stiell IG, Clement CM, McKnight RD, Brison R, Schull MJ, Rowe BH, Worthington JR, Eisenhauer MA, Cass D, Greenberg G, MacPhail I, Dreyer J, Lee JS, Bandiera G, Reardon M, Holroyd B, Lesiuk H, Wells GA.
N Engl J Med. 2003 Dec 25;349(26):2510-8.

Rationale for inclusion: A comparison of NEXUS low-risk criteria and Canadian C-spine rule determined that the Canadian C-spine rule was both more sensitive and specific for injury while utilizing fewer imaging studies.

CAVEAT: The study investigators were the creators of the Canadian C-spine rule.

Citations - 425 (as of July 2017)

The Canadian C-spine rule for radiography in alert and stable trauma patients.
Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, Laupacis A, Schull M, McKnight RD, Verbeek R, Brison R, Cass D, Dreyer J, Eisenhauer MA, Greenberg GH, MacPhail I, Morrison L, Reardon M, Worthington J.
JAMA. 2001 Oct 17;286(15):1841-8.

Rationale for inclusion: The Canadian C-spine rule created another decision tool to help clinicians decide when further cervical spine imaging is needed in alert, stable trauma patients.

Citations - 819 (as of July 2017)

Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group.
Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI.
N Engl J Med. 2000 Jul 13;343(2):94-9.

Rationale for inclusion: The NEXUS trial established a set of clinical criteria to help physicians identify patients who warrant imaging of their cervical spine.

Citations - 961 (as of July 2017)

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