Exclusion of cervical spine injury: A prospective study

Stephen M. Cohn, W. Glenn Lyle, Christopher H. Linden, Robert A. Lancey

Research output: Contribution to journalArticlepeer-review

38 Scopus citations

Abstract

Trauma room lateral cervical spine radiographs (LCSR) may improve the safety of intubation and transportation of multiply injured patients by providing earlier recognition of spinal vertebral injuries. We prospectively evaluated 60 consecutive trauma admissions to determine the impact of clearance of cervical spine radiographs on patient care. Fifty-three patients had no cervical spine injury (CSI). Intubations, emergency head CT scan, aortography, or urgent operation (<6 hours after admission) were required in the majority of patients and preceded complete cervical spine clearance in all but one instance. The median time for radiologic clearance of the cervical spine was 15 hours (range, 1.5 to 181). LCSR failed to identify three of the seven acute CSI (all three had C7 fractures). The spine-injured were managed with cervical collars and no new neurologic injury developed. We conclude that: 1) LCSRs do not appear to alter urgent management of multiply injured patients during resuscitation and transportation; 2) chest radiographs and emergency investigations should not be delayed by repeated LCSR in the trauma room as it may be difficult to fully exclude CSI in many trauma patients; 3) we support the current ATLS guidelines, which suggest that all patients should be presumed to have an unstable CSI until the presence of cervical injury has been excluded.

Original languageEnglish (US)
Pages (from-to)570-574
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume31
Issue number4
DOIs
StatePublished - Apr 1991

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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