C-Spine Collar Clearance In The Obtunded Adult Blunt Trauma Patient

Cervical spine collar clearance in the obtunded adult from Sun YaiCheng

Cervical Spine Collar Clearance In The Obtunded Adult Blunt Trauma Patient
A systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma

J Trauma Acute Care Surg. 2015;78: 430-441.

PICO

• 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.

Inclusion Criteria

• 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

RECOMMENDATION

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% 

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【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%﹞