Cervical spine clearance in Australian intensive care units

Rigid or semi-rigid collar and spine board related complications may be causes of significant morbidity in intubated polytraumatised patients. As the process quantifying cervical spine injuries is controversial, exclusion of cervical spinal injuries (cervical spine clearance) can be delayed, thereby increasing complications associated with spinal cord immobilisation. We examined current practices in Australian ICUs by survey.

The intensive care unit or trauma services director and the senior nursing unit manager from 17 units within designated Australian trauma centres were surveyed separately by telephone. The presence of a written protocol for cervical spine clearance including radiological and clinical criteria, time goals for clearance, immobilisation methods and formal surveillance of collar related complications were assessed using a standardised questionnaire.

All states and territories were represented. Of those services surveyed, only 50% had a written protocol, 50% had no specific time goal for cervical spinal clearance and the method of clearance ranged from plain cervical spine X-rays only to routine use of MRI. Immobilisation methods also varied, including use of rigid (hard) or soft collars with 71% having no formal surveillance of collar-related complications. Despite these results, 65% were satisfied with their approach to cervical spine clearance.

There is no standardised approach to the clearance of the cervical spine in intubated trauma patients in Australian intensive care units. In addition, morbidity from current practices and the true incidence of cervical spine injuries remains unknown. We recommend use of a written protocol and formal documentation of collar related complications. A standardised approach to radiological and clinical clearance of cervical spine injuries, which is practical, yet safe, remains a subject for future risk-benefit analysis.