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Cervical Spine Clearance in the Obtunded Patient

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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)

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