Cervical spine clearance protocols vary considerably

(HealthDay)—Cervical spine clearance protocols for level-1 trauma centers are highly variable, according to a study published in the March 1 issue of Spine.

Alexander A. Theologis, M.D., from the University of California-San Francisco, and colleagues contacted 191 U.S. level-1 trauma centers (response rate, 87 percent) and reviewed all available cervical spine clearance protocols. Four scenarios were evaluated for each protocol: clearing asymptomatic patients; imaging for patients who are not amenable to clinical clearance; management strategies for patients with persistent neck pain and negative computed tomographic (CT) scan; and those who are obtunded.

The researchers found that 57 percent of institutions had cervical spine clearance protocols. In 89 percent of protocols, the National Emergency X-Radiography Utilization Study criteria were recommended to clear asymptomatic patients. CT scans were used as first-line imaging in 60 percent of protocols. Flexion-extension plain radiographs were the most common (30 percent) next step for clearance in patients with persistent neck pain and negative CT scan. A CT scan followed by magnetic resonance imaging was the most common method (31 percent) of clearance in obtunded patients. Dynamic flexion-extension views were recommended for patients who are obtunded in 8 percent of protocols, despite being contraindicated.

"These protocols are highly variable and standardization and utilization of these protocols should be encouraged in all trauma centers to prevent missed injuries and neurological catastrophes," the authors write.

Relevant financial activities outside the submitted work were disclosed: board membership, expert testimony, consultant, royalties, patents, and stock options.