Clinical Examination in Complement With Computed Tomography Scan: An Effective Method for Identification of Cervical Spine Injury

Gonzalez, Richard P.; Cummings, Glenn R.; Phelan, Herbert; Bosarge, Patrick L.; Rodning, Charles B.

doi:10.1097/ta.0b013e3181c0b604

Cited by 16 publications

(6 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regarding the need for CT of the cervical spine, physical examination of the cervical spine is unreliable in patients who are not awake and alert. [17] Although Gonzalez et al [17] question the significance of distracting injuries, reputable organisations such as the Eastern Association for the Surgery of Trauma [18] continue to caution that clinical examination is unreliable in the presence of distracting injuries. The exact definition of distracting injuries remains unclear and calls for clinical judgement.…”

Section: Discussionmentioning

confidence: 99%

Pan computed tomography for blunt polytrauma: Are we doing too many?

et al. 2016

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Pan computed tomography for blunt polytrauma: Are we doing too many?

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Detection of cervical spine injury among neurologically intact blunt trauma patients with persistent neck pain and negative computed tomography (CT) imaging presents an important clinical challenge. The overall rate of cervical spine injury in blunt trauma patients is 7%-15%, 1 and the NEXUS criteria are widely used to guide clinical evaluation of cervical spine injury. 2 CT scan is the recommended imaging modality, 3 as it is highly sensitive for bony injury.…”

Section: Introductionmentioning

confidence: 99%

“…However, this too is controversial, as MRI has a high false-positive rate, potentially leading to unnecessary cervical collar treatment as well as delay of care while MRI is obtained. 1,2,4,6 To date, studies assessing the efficacy of MRI in blunt trauma patients with negative CT and persistent neck pain have yielded mixed results; [7][8][9][10][11][12][13][14][15] a recent metaanalysis concluded that insufficient data exist for determining whether MRI should be used in this population. 4 Given the paucity of useful data, we performed a retrospective review of neurologically intact blunt trauma patients presenting to our level Copyright 2020 by International Society for the Advancement of Spine Surgery.…”

Section: Introductionmentioning

confidence: 99%

The Utility of Magnetic Resonance Imaging for Detecting Unstable Cervical Spine Injuries in the Neurologically Intact Traumatized Patient Following Negative Computed Tomography Imaging

et al. 2020

View full text Add to dashboard Cite

Background: Neurologically intact blunt trauma patients with persistent neck pain and negative computed tomography (CT) imaging frequently undergo magnetic resonance imaging (MRI) for evaluation of occult cervical spine injury. There is a paucity of data to support or refute this practice. This study was therefore performed to evaluate the utility of cervical spine MRI in neurologically intact blunt trauma patients with negative CT imaging.Methods: A retrospective review was performed of all neurologically intact blunt trauma patients presenting to a level 1 trauma center from 2005 to 2015 with persistent neck pain and negative CT imaging. The proportion of patients with positive MRI findings, subsequent treatment, and time required to obtain MRI results was evaluated.Results: Of 223 patients meeting inclusion criteria, 11 had positive MRI findings; however, no patients were found to have unstable injuries requiring surgical treatment. The process for a complete evaluation of unstable cervical spine injury from the time of obtaining a CT scan was 19 hours and 43 minutes.Conclusions: Eleven patients had positive MRI findings, yet these findings did not alter treatment. In contrast, the time required to obtain MRI results may substantially delay patient care.Level of Evidence: IV (retrospective case series) Clinical Relevance: Our results demonstrate that MRI has limited utility in neurologically intact blunt trauma patients with negative CT imaging.

show abstract

“…4 Current c-spine guidelines, however, require continued spinal immobilization, performance of a clinical examination, referred to as a confrontational examination, and in the presence of cervical spine tenderness, further radiographic studies to assess for possible ligamentous injury. 5 Although c-spine protocols emphasize the importance of a clinical examination prior to c-collar removal, there is little emphasis in the literature to guide physicians on the performance of a proper examination of the cervical spine. Even when steps are appropriately followed, the documentation is often sporadic, communication poor, and the timeliness of collar removal not documented thereby leading to significant legal ramifications where it is often theorized that work not documented is work not done.…”

mentioning

confidence: 99%

Use of an Electronic C-Spine Clearance Strategy to Ensure Compliance With Confrontational Examinations

Cardozo

Angus²

2015

Journal of Trauma Nursing

View full text Add to dashboard Cite

The implementation of electronic medical records (EMRs) represents one of the most significant changes taking place in the medical field today. The purpose of this Performance Improvement Patient Safety initiative was to evaluate and improve the documentation of c-spine clearances by standardizing the confrontational spine examination for patients sustaining blunt trauma using the EMR. A retrospective audit of trauma charts was performed over a 6-month period to evaluate c-spine clearance documentation. Following the initial audit, a strategy, using the Donabedian Principle of problem identification, process establishment, and outcome measure, was created resulting in a template in the EMR whereby clearance of the cervical spine (confrontational examination) in nonobtunded trauma patients was standardized for all providers. Outcomes before and after implementation of the EMR protocol were compared. The initial audit revealed that 71% of records lacked appropriate documentation. Of those with documentation, 26% simply stated "c-spine cleared" or "collar removed" with no documentation to support the clinical examination performed. This is in contrast to a 95% compliance rate following the use of the EMR protocol. Up to 80% of collars were removed within 3 hours of admission thereby reducing complications associated with c-collars. The use of the EMR allowed for the standardization of the cervical spine clearance, improved documentation, and allowed for the monitoring of compliance with evidenced-based c-spine protocols. Practice implications and lessons learned in the implementation of this successful Performance Improvement Patient Safety are also described.

show abstract

Clinical Examination in Complement With Computed Tomography Scan: An Effective Method for Identification of Cervical Spine Injury

Cited by 16 publications

References 39 publications

Pan computed tomography for blunt polytrauma: Are we doing too many?

Pan computed tomography for blunt polytrauma: Are we doing too many?

The Utility of Magnetic Resonance Imaging for Detecting Unstable Cervical Spine Injuries in the Neurologically Intact Traumatized Patient Following Negative Computed Tomography Imaging

Use of an Electronic C-Spine Clearance Strategy to Ensure Compliance With Confrontational Examinations

Contact Info

Product

Resources

About