title: Discontinuation of cervical spine immobilisation in unconscious patients with trauma in intensive care units--telephone survey of practice in south and west region.
abstract: OBJECTIVE
  To study how the cervical spine is assessed before discontinuation of cervical spine immobilisation in unconscious trauma patients in intensive care units.
  
  
  METHODS
  Telephone interview of consultants responsible for adult intensive care units.
  
  
  METHODS
  All 25 intensive care units in the South and West region that admit victims of major trauma.
  
  
  METHODS
  The clinical and radiological basis on which the decision is made to stop cervical spine immobilisation in unconscious patients with trauma.
  
  
  RESULTS
  In 19 units cervical spine immobilisation was stopped in unconscious patients on the basis of radiology alone, and six units combined radiology with clinical examination after the patient had regained consciousness. Sixteen units relied on a normal lateral radiological view of the cervical spine alone, five required a normal lateral and anteroposterior view, and four required a normal lateral, anteroposterior, and open mouth peg view.
  
  
  CONCLUSIONS
  There are inconsistencies in the clinical and radiological approach to assessing the cervical spine in unconscious patients with trauma before the removal of immobilisation precautions. There is an overreliance on the lateral cervical spine view alone, which has been shown to be insensitive in this setting.
authors.affiliation: Department of Anaesthesia, Frenchay Hospital, Bristol.
authors.forename: K J
authors.initials: KJ
authors.lastname: Gupta
authors.forename: M
authors.initials: M
authors.lastname: Clancy
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D003253:Consultants; D003657:Decision Making; D004739:England; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007103:Immobilization; D007362:Intensive Care Units; D008505:Medical Staff, Hospital; D010818:Practice Patterns, Physicians'; D011859:Radiography; D014474:Unconsciousness / Q000000981:diagnostic imaging / Q000628:therapy*