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Current practice in clinical cervical spinal clearance: implication for EMS

D C Cone1, G C Wydro, C M Mininger

  • 1Department of Emergency Medicine, MCP-Hahnemann School of Medicine, Allegheny University of the Health Sciences, Philadelphia, Pennsylvania 19129-1121, USA. cone@auhs.edu

Prehospital Emergency Care
|January 28, 1999
PubMed
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Emergency departments show significant variation in cervical spine (c-spine) clearance practices for trauma patients. This inconsistency may impede the development of standardized prehospital c-spine clearance protocols.

Area of Science:

  • Emergency Medicine
  • Trauma Care
  • Spinal Injury Management

Background:

  • Cervical spine (c-spine) immobilization is standard for trauma patients arriving via Emergency Medical Services (EMS).
  • Clinical clearance of the c-spine in the Emergency Department (ED) aims to reduce unnecessary imaging.

Purpose of the Study:

  • To examine current ED practices for clinically clearing the c-spine of immobilized trauma patients.
  • To investigate developing trends in prehospital c-spine clearance protocols.

Main Methods:

  • A 12-question survey was distributed to physician medical directors of 300 randomly selected EDs.
  • Survey questions addressed ED clearance practices, EMS protocols, and attitudes toward prehospital clearance.

Main Results:

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  • A 58% response rate (173 surveys) was achieved.
  • 12% of hospitals obtain c-spine films for all immobilized patients; clinical clearance is never attempted.
  • Clinical clearance is attempted in 65.5% of eligible patients and successful in 53.7% of attempts.
  • Significant variation exists in clearance practices among ED physicians (42%).
  • 57% of respondents believe trained EMS providers can attempt clinical clearance on low-risk trauma patients.

Conclusions:

  • There is substantial variability in ED clinical c-spine clearance practices.
  • Lack of support from ED directors may hinder research and standardization of prehospital c-spine clearance protocols.