Outcomes of Patients With Negative Cervical Imaging but Persistent Neck Tenderness Discharged With a Rigid Collar...

Area of Science:

• Trauma care
• Orthopedic surgery

Background:

• Persistent neck pain after trauma, despite negative cervical imaging, often leads to discharge with a rigid cervical collar.
• Protocols for managing these patients vary, with limited research on clinical outcomes and patient experiences post-discharge.

Purpose of the Study:

• To evaluate clinical outcomes and patient experiences in adults discharged with a rigid cervical collar after blunt trauma and negative cervical spine imaging.
• To assess the incidence of missed injuries, self-discontinuation of collar use, and collar-related complications.

Main Methods:

• A cohort of 45 adult patients with blunt trauma and negative cervical spine imaging discharged in a rigid cervical collar were analyzed over 19 months.
• Primary outcome: identification of missed injuries post-discharge. Secondary outcomes: patient self-clearing from collars and collar-related complications.

Main Results:

• No missed traumatic injuries were identified on follow-up imaging.
• Twenty out of 45 patients self-discharged from their collars without medical orders.
• Over half of the patients reported complications, including pain, skin irritation, sleep disturbances, and difficulty with speech or swallowing.

Conclusions:

• Complications associated with rigid cervical collar use in trauma patients with negative imaging are frequent.
• Follow-up imaging did not alter outpatient management decisions.
• The findings suggest reconsidering the practice of discharging trauma patients with negative imaging and no neurological deficits while wearing a cervical collar.