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Cervical Spine Clearance in Trauma Patients with an Unreliable Physical Examination

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@article{415bd0845eac424cbb573a9ef105b912,
title = "Cervical Spine Clearance in Trauma Patients with an Unreliable Physical Examination",
abstract = "BACKGROUND: The objective of this study was to describe and compare the timing of cervical spine clearance in trauma patients with an unreliable physical examination.METHODS: We prospectively included adult trauma patients admitted with a cervical collar and an unreliable clinical examination (as defined by the NEXUS criteria) at two level 1 trauma centers: one in the USA (US) and one in Denmark (DK). We excluded patients with cervical spine injuries requiring a collar or surgery as treatment and patients with a collar placed after hospital arrival. The primary outcome was time from emergency department (ED) arrival to collar removal. Secondary outcomes included time to CT of the cervical spine (CTCS). At the US trauma center, an institutional protocol allowing cervical spine clearance exclusively by CTCS was in place. At the Danish trauma center, cervical spine clearance was based on a clinical evaluation by an orthopedic surgeon, usually after CTCS.RESULTS: A total of 113 patients were included (US: n = 56; DK: n = 57). The median age was 47 years, and 68% were males. The main reasons for an unreliable physical examination were a Glasgow Coma Scale score below 14 (35%), distracting injuries (26%), cervical spine tenderness (13%) and intoxication (13%). The injury severity score at the US trauma center was higher than at the DK trauma center (median: 17 vs. 11, p = 0.03). Both time to CTCS (median: 41 vs. 18 min, p < 0.0001) and time to collar removal (median: 1042 vs. 49 min, p < 0.0001) were significantly greater at the US trauma center.CONCLUSIONS: Time to collar removal was significantly greater in a trauma center utilizing a cervical spine clearance protocol based on CTCS. As patients may develop complications related to the collar, future studies should clarify how early removal can be implemented without increasing the risk of morbidity.",
author = "Baekgaard, {Josefine S} and Christensen, {Rasmus Ejlersgaard} and Lee, {Jae Moo} and Eid, {Ahmed I} and Eskesen, {Trine G} and Jacob Steinmetz and Rasmussen, {Lars S} and King, {David R} and Velmahos, {George C}",
year = "2020",
month = apr,
day = "1",
doi = "10.1007/s00268-019-05307-1",
language = "English",
volume = "44",
pages = "1113--1120",
journal = "World Journal of Surgery",
issn = "0364-2313",
publisher = "Springer New York LLC",
number = "4",

}

RIS

TY - JOUR

T1 - Cervical Spine Clearance in Trauma Patients with an Unreliable Physical Examination

AU - Baekgaard, Josefine S

AU - Christensen, Rasmus Ejlersgaard

AU - Lee, Jae Moo

AU - Eid, Ahmed I

AU - Eskesen, Trine G

AU - Steinmetz, Jacob

AU - Rasmussen, Lars S

AU - King, David R

AU - Velmahos, George C

PY - 2020/4/1

Y1 - 2020/4/1

N2 - BACKGROUND: The objective of this study was to describe and compare the timing of cervical spine clearance in trauma patients with an unreliable physical examination.METHODS: We prospectively included adult trauma patients admitted with a cervical collar and an unreliable clinical examination (as defined by the NEXUS criteria) at two level 1 trauma centers: one in the USA (US) and one in Denmark (DK). We excluded patients with cervical spine injuries requiring a collar or surgery as treatment and patients with a collar placed after hospital arrival. The primary outcome was time from emergency department (ED) arrival to collar removal. Secondary outcomes included time to CT of the cervical spine (CTCS). At the US trauma center, an institutional protocol allowing cervical spine clearance exclusively by CTCS was in place. At the Danish trauma center, cervical spine clearance was based on a clinical evaluation by an orthopedic surgeon, usually after CTCS.RESULTS: A total of 113 patients were included (US: n = 56; DK: n = 57). The median age was 47 years, and 68% were males. The main reasons for an unreliable physical examination were a Glasgow Coma Scale score below 14 (35%), distracting injuries (26%), cervical spine tenderness (13%) and intoxication (13%). The injury severity score at the US trauma center was higher than at the DK trauma center (median: 17 vs. 11, p = 0.03). Both time to CTCS (median: 41 vs. 18 min, p < 0.0001) and time to collar removal (median: 1042 vs. 49 min, p < 0.0001) were significantly greater at the US trauma center.CONCLUSIONS: Time to collar removal was significantly greater in a trauma center utilizing a cervical spine clearance protocol based on CTCS. As patients may develop complications related to the collar, future studies should clarify how early removal can be implemented without increasing the risk of morbidity.

AB - BACKGROUND: The objective of this study was to describe and compare the timing of cervical spine clearance in trauma patients with an unreliable physical examination.METHODS: We prospectively included adult trauma patients admitted with a cervical collar and an unreliable clinical examination (as defined by the NEXUS criteria) at two level 1 trauma centers: one in the USA (US) and one in Denmark (DK). We excluded patients with cervical spine injuries requiring a collar or surgery as treatment and patients with a collar placed after hospital arrival. The primary outcome was time from emergency department (ED) arrival to collar removal. Secondary outcomes included time to CT of the cervical spine (CTCS). At the US trauma center, an institutional protocol allowing cervical spine clearance exclusively by CTCS was in place. At the Danish trauma center, cervical spine clearance was based on a clinical evaluation by an orthopedic surgeon, usually after CTCS.RESULTS: A total of 113 patients were included (US: n = 56; DK: n = 57). The median age was 47 years, and 68% were males. The main reasons for an unreliable physical examination were a Glasgow Coma Scale score below 14 (35%), distracting injuries (26%), cervical spine tenderness (13%) and intoxication (13%). The injury severity score at the US trauma center was higher than at the DK trauma center (median: 17 vs. 11, p = 0.03). Both time to CTCS (median: 41 vs. 18 min, p < 0.0001) and time to collar removal (median: 1042 vs. 49 min, p < 0.0001) were significantly greater at the US trauma center.CONCLUSIONS: Time to collar removal was significantly greater in a trauma center utilizing a cervical spine clearance protocol based on CTCS. As patients may develop complications related to the collar, future studies should clarify how early removal can be implemented without increasing the risk of morbidity.

U2 - 10.1007/s00268-019-05307-1

DO - 10.1007/s00268-019-05307-1

M3 - Journal article

C2 - 31802188

VL - 44

SP - 1113

EP - 1120

JO - World Journal of Surgery

JF - World Journal of Surgery

SN - 0364-2313

IS - 4

ER -

ID: 58541562