Evaluation of the acute cervical spine: a management algorithm

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Radiology

Background:

• Evaluating the cervical spine in trauma patients requires a safe, efficient, and cost-effective approach.
• A Level I trauma facility developed a unified cervical spine clearance protocol involving multiple departments.
• This study evaluates the effectiveness of the new protocol in preventing missed cervical spine injuries.

Purpose of the Study:

• To assess the effectiveness of a newly implemented cervical spine clearance protocol.
• To determine the incidence of missed cervical spine injuries before and after protocol implementation.

Main Methods:

• A retrospective review of trauma patients over a 2-year period (pre- and post-protocol implementation) was conducted.
• Data included patient demographics, injury types, and diagnostic findings for cervical spine injuries.
• An additional 6 months were reviewed to capture late-diagnosed injuries.

Main Results:

• In the pre-protocol year, 3.4% of patients had cervical spine injuries, with 3 cases missed. In the post-protocol year, 3.4% had injuries, and no cases were missed.
• Approximately 45% of patients required further cervical radiographs under the protocol.
• No statistically significant differences were observed in injury rates or characteristics between the pre- and post-protocol periods, except for missed injuries.

Conclusions:

• The implemented cervical spine clearance protocol is effective.
• Risk stratification of patients upon presentation aids in accurate cervical spine injury assessment.
• The protocol successfully reduced the incidence of missed cervical spine injuries in the trauma setting.