`Clearing' the cervical spine in conscious trauma patients

Abstract

This is a systematic review of published evidence regarding management of the cervical spine in conscious and co-operative trauma patients. We examine the literature in the following sections: clinical evaluation of the cervical spine; use of plain radiography; use of additional radiographic views; use of computed tomography; use of magnetic resonance imaging. Finally we consider the elderly and paediatric populations, particularly where there are significant differences compared to the general adult population. This paper also reviews the literature regarding non-medical assessment of the cervical spine. We conclude that there are well-validated decision rules available to guide the clinician, and that each imaging strategy has distinct advantages and disadvantages. Familiarity with these issues provides a sound basis for safe and effective decision-making.

Pre-hospital spinal immobilisation: an initial consensus statement

“…A 2009 review also concluded that the alert, cooperative patient does not require immobilisation even if a clinical decision rule is positive, unless their conscious level deteriorates 12. They state that muscle spasm is a superior method to an artificial procedure.…”

Prehospital spinal immobilisation: an initial consensus statement

“…A 2009 review also concluded that the alert, cooperative patient does not require immobilisation even if a clinical decision rule is positive, unless their conscious level deteriorates. 12 They state that muscle spasm is a superior method to an artificial procedure. The College of Emergency Medicine guidance emphasises the need for large-scale studies 13 while acknowledging the ethical conundrum that, “ the current practice … is so widely adopted and the consequences of causing or exacerbating a spinal injury so catastrophic that such trials may not be supported .”…”

‘Clearing’ the cervical spine in the unconscious trauma patient

“…In a previous paper we presented the available evidence regarding cervical spine 'clearance' in the conscious and co-operative trauma patient (Blackham and Benger 2009). Clearance in unconscious patients is an even greater challenge because a key aspect of the clinical evaluation is absent, and therefore immobilisation may be maintained for long periods with an increased risk of complications.…”