Fri., 10/14/11 Pelvis & Spine, Paper #40, 10:00 am OTA-2011
Cervical Spine Clearance Protocols in Level I, II and III Trauma Centers in the State of California
Murat Pekmezci, MD; Roberto Dinisio, BS; Geoffrey Manley, MD; Robert Mackersie, MD; R. Trigg McClellan, MD;
University of California San Francisco, San Francisco General Hospital,
San Francisco, California, USA
Purpose: Cervical spine clearance protocols have been developed to standardize the clearance of C-spine following high-energy blunt trauma and prevent neurologic deficits secondary to missed unstable spine injuries. The guidelines on cervical spine clearance are evolving as new imaging techniques become more available. Ideally each trauma center should develop and update their cervical spine clearance protocols; however, this is not mandatory. The purpose of this study is to evaluate the cervical spine clearance practice in trauma centers in the State of California.
Methods: Level 1 (n = 15), 2 (n = 30), and 3 (n = 11) trauma centers in the State of California were identified through the Trauma Managers Association of California website. The trauma managers in these centers are contacted via e-mail and phone calls. If the center has an official cervical spine clearance protocol, these protocols were evaluated to understand their current practice.
Results: Overall, only 50% of all trauma centers in California had a cervical spine clearance protocol. Specifically, 80% of Level 1, 47% of Level 2, and only 18% of Level 3 trauma centers had an official cervical spine clearance protocol. Of the centers that have an official C-spine clearance protocol, 67% of Level 1 and 57% of Level 2 centers use Nexus criteria with/without painless range of motion to clear asymptomatic patients. 67% of Level 1 and 64% of Level 2 centers use multi-detector CT scans as the first line of imaging in symptomatic patients. 58% of Level 1 and 28% of Level 2 centers prefer MRI in addition to CT scans, whereas 25% of Level 1 and 21% of Level 2 centers prefer CT scan only to clear cervical spine of obtunded patients. Only 2 Level 3 centers had protocols; however, they were not clear with regard to the algorithm that should be followed.
Conclusions: This study showed that only 50% of the trauma centers in California have an official cervical spine clearance protocol and only 30% of the centers have protocols that follow current recommendations. Policies should be made to improve the quality and use of official cervical spine protocols in all trauma centers.
Alphabetical Disclosure Listing (628K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.