Cervical Spine Collar Clearance In The Obtunded Adult Blunt Trauma PatientJ Trauma Acute Care Surg. 2015;78: 430-441.
A systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma
- Population: In the obtunded adult blunt trauma patient
- Intervention: Should cervical collar removal be performed after a negative high-quality C-spine CT result combined with adjunct imaging?
- Comparator: Should cervical collar removal be performed after a negative high-quality C-spine CT result alone?
- Outcome:To reduce peri-clearance events, such as new neurologic change (paraplegia, quadriplegia), unstable C-spine injury (subcategories, treated with operation or treated with orthotic), stable C-spine injury (subcategories treated with operation or treated with orthotic), post-clearance imaging, false-negative CT imaging result on re-review, pressure ulcers, and time to cervical collar clearance.
- Adult blunt trauma patients > 16 years
- C-spine CT with axial thickness < 3 mm
- Obtunded definition: GCS score < 15, unconscious, intubated, altered mental status, un-reliable examination, distracting injury, intoxication, or not meeting NEXUS guidelines
In obtunded adult blunt trauma patients, we conditionally recommend cervical collar removal after a negative high-quality C-spine CT scan result alone.
NPV of CT C-spine for an Unstable Injury: 100%
NPV of CT C-spine for an Stable Injury: 90.6%
【摘要】 意識不清傷患之頸圈移除建議 ﹝2015 EAST Guideline﹞
C-spine CT negative finding 之意識不清傷患，建議視情況移除頸圈﹝Unstable C-Spine Injury NPV: 100%; Stable C-Spine Injury NPV: 90.6%﹞