Evaluation of the Oxford protocol for total spinal clearance in the unconscious trauma patient

Prolonged use of spinal precautions in unconscious trauma patients is associated with significant morbidity. The trauma service of the John Radcliffe Hospital uses full-length radiography, computed tomographic scanning, and dynamic screening of the cervical spine to clear the spine at the earliest opportunity.

The results in 210 consecutive patients were reviewed. Seventy-eight patients underwent dynamic screening of the cervical spine.

Five of these patients had a cervical fracture or instability. One patient had demonstrated minor changes only on plain radiography but gross instability on dynamic screening. There were no neurologic sequelae from dynamic screening and no fractures were missed. Collar removal was possible in all but one patient a median 3 days before extubation and 1 day after admission to the intensive care unit.

Full length spinal radiography and dynamic cervical screening may allow early and safe discontinuation of spinal precautions in the unconscious trauma patient in whom clinical signs are absent or unreliable.