Background: Cervical spine clearance in intubated patients due to blunt trauma remains contentious. Accumulating evidence suggests that a normal computed tomography (CT) cervical spine can be used to clear the cervical spine and remove the collar in unconscious patients presenting to the emergency department. However, whether this strategy can safely be employed by critical care physicians with intubated patients admitted to the trauma intensive care unit (TICU) with cervical collars in situ, has not been definitively studied. Methods: A retrospective review of 730 intubated victims of trauma who presented to the Level 1 Trauma center of a tertiary hospital was conducted. The rates of missed cervical injuries in patients who had their cervical collars removed by intensive care physicians based on a normal CT scan of the cervical spine, were reviewed. Secondary outcomes included rates of collar-related complications. Results: Three hundred and fifty patients had their cervical collars removed by Trauma ICU doctors based on a high-quality, radiologist-interpreted normal CT cervical spine. Seventy percent of patients were sedated and/or comatose at the time of collar removal. Fifty-one percent of patients had concomitant traumatic brain injury. The average GCS at time of collar removal was 9. The incidence of missed neurological injury discerned clinically at time of both ICU and hospital discharge was nil (negative predictive value 100%). The rate of collar-related complications was 2%. Conclusion: Cervical collar removal by intensive care physicians on TICU following normal CT cervical spine, is safe, provided certain quality conditions related to the CT scan are met. Not removing the collar early may be associated with increased complications. An algorithm is suggested to assist critical care decision-making in this patient cohort.

Background: Cervical spine clearance in intubated victims of blunt trauma remains contentious; accumulating high level evidence suggests that a normal CT cervical spine can be used to clear the c-spine and remove the collar in obtunded emergency department patients to prevent collar-related complications. However, it is unclear whether this holds true for intubated patients in the trauma intensive care unit (TICU).Methods: We performed a retrospective review of 730 intubated trauma patients who presented to the Level 1 Trauma center of a tertiary hospital. We reviewed the rate of missed cervical injuries in patients who had their cervical collars removed based on a normal computed tomography (CT) scan of the cervical spine, as well as rates of collar-related complications.Results: Three hundred and fifty patients had their cervical collars removed in the TICU based on the findings of a high-quality, well-interpreted normal CT cervical spine. Seventy percent of patients were intubated and sedated at the time of collar removal. Fifty-one percent of patients had concomitant traumatic brain injury. The average GCS at time of collar removal was 9. The incidence of missed neurological injury discerned clinically at time of both ICU and hospital discharge was nil (negative predictive value 100%). The rate of collar-related complications was 2%.Conclusion: Based on our findings, it is safe to remove the cervical collar for patients in the TICU following normal CT cervical spine, provided certain quality conditions related to the CT scan are met. Not removing the collar early may be related to increased complications. We provide an algorithm to assist critical-care clinicians in decision-making in this patient cohort