TY - JOUR
T1 - Cervical spine collar clearance in the obtunded adult blunt trauma patient
T2 - A systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma
AU - Patel, Mayur B.
AU - Humble, Stephen S.
AU - Cullinane, Daniel C.
AU - Day, Matthew A.
AU - Jawa, Randeep S.
AU - Devin, Clinton J.
AU - Delozier, Margaret S.
AU - Smith, Lou M.
AU - Smith, Miya A.
AU - Capella, Jeannette M.
AU - Long, Andrea M.
AU - Cheng, Joseph S.
AU - Leath, Taylor C.
AU - Falck-Ytter, Yngve
AU - Haut, Elliott R.
AU - Como, John J.
N1 - Publisher Copyright:
Copyright © 2015 by Wolters Kluwer Health, Inc. All rights reserved.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Background: With the use of the framework advocated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE)Working Group, our aimswere to perform a systematic reviewand to develop evidence-based recommendations that may be used to answer the following PICO [Population, Intervention, Comparator, Outcomes] question: In the obtunded adult blunt trauma patient, should cervical collar removal be performed after a negative high-quality cervical spine (C-spine) computed tomography (CT) result alone or after a negative high-quality C-spine CT result combined with adjunct imaging, to reduce peri-clearance events, such as new neurologic change, unstable C-spine injury, stable C-spine injury, need for post-clearance imaging, false-negative CT imaging result on re-review, pressure ulcers, and time to cervical collar clearance? Methods: Our protocol was registered with the PROSPERO international prospective register of systematic reviews on August 23, 2013 (Registration Number: CRD42013005461). Eligibility criteria consisted of adult blunt trauma patients 16 years or older, who underwent C-spine CT with axial thickness of less than 3 mm and who were obtunded using any definition. Quantitative synthesis via meta-analysis was not possible because of pre-post, partial-cohort, quasi-experimental study design limitations and the consequential incomplete diagnostic accuracy data. Results: of five articles with a total follow-up of 1,017 included subjects, none reported new neurologic changes (paraplegia or quadriplegia) after cervical collar removal. There is a worst-case 9% (161 of 1,718 subjects in 11 studies) cumulative literature incidence of stable injuries and a 91% negative predictive value of no injury, after coupling a negative high-quality C-spine CT result with 1.5-T magnetic resonance imaging, upright x-rays, flexion-extension CT, and/or clinical follow-up. Similarly, there is a best-case 0% (0 of 1,718 subjects in 11 studies) cumulative literature incidence of unstable injuries after negative initial imaging result with a high-quality C-spine CT. Conclusion: In obtunded adult blunt trauma patients, we conditionally recommend cervical collar removal after a negative high-quality C-spine CT scan result alone. Level of Evidence: Systematic review, level III.
AB - Background: With the use of the framework advocated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE)Working Group, our aimswere to perform a systematic reviewand to develop evidence-based recommendations that may be used to answer the following PICO [Population, Intervention, Comparator, Outcomes] question: In the obtunded adult blunt trauma patient, should cervical collar removal be performed after a negative high-quality cervical spine (C-spine) computed tomography (CT) result alone or after a negative high-quality C-spine CT result combined with adjunct imaging, to reduce peri-clearance events, such as new neurologic change, unstable C-spine injury, stable C-spine injury, need for post-clearance imaging, false-negative CT imaging result on re-review, pressure ulcers, and time to cervical collar clearance? Methods: Our protocol was registered with the PROSPERO international prospective register of systematic reviews on August 23, 2013 (Registration Number: CRD42013005461). Eligibility criteria consisted of adult blunt trauma patients 16 years or older, who underwent C-spine CT with axial thickness of less than 3 mm and who were obtunded using any definition. Quantitative synthesis via meta-analysis was not possible because of pre-post, partial-cohort, quasi-experimental study design limitations and the consequential incomplete diagnostic accuracy data. Results: of five articles with a total follow-up of 1,017 included subjects, none reported new neurologic changes (paraplegia or quadriplegia) after cervical collar removal. There is a worst-case 9% (161 of 1,718 subjects in 11 studies) cumulative literature incidence of stable injuries and a 91% negative predictive value of no injury, after coupling a negative high-quality C-spine CT result with 1.5-T magnetic resonance imaging, upright x-rays, flexion-extension CT, and/or clinical follow-up. Similarly, there is a best-case 0% (0 of 1,718 subjects in 11 studies) cumulative literature incidence of unstable injuries after negative initial imaging result with a high-quality C-spine CT. Conclusion: In obtunded adult blunt trauma patients, we conditionally recommend cervical collar removal after a negative high-quality C-spine CT scan result alone. Level of Evidence: Systematic review, level III.
KW - Blunt trauma
KW - Cervical collar
KW - Cervical spine
KW - Clearance
KW - Obtunded
UR - http://www.scopus.com/inward/record.url?scp=84925873968&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84925873968&partnerID=8YFLogxK
U2 - 10.1097/TA.0000000000000503
DO - 10.1097/TA.0000000000000503
M3 - Review article
C2 - 25757133
AN - SCOPUS:84925873968
SN - 2163-0755
VL - 78
SP - 430
EP - 441
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 2
ER -