Clearing the cervical spine in unconscious adult trauma patients: a survey of practice in specialist centres in the UK.
A postal questionnaire survey of neurosurgery and spinal injury departments in the UK was conducted to determine how they assessed the cervical spine in unconscious, adult trauma patients, and at what point immobilisation was discontinued. Of the 32 units contacted, 27 responded (response rate, 84%). Most centres had no protocols to guide initial imaging or when immobilisation devices should be removed. Most responding centres performed fewer than three plain radiographs, and most did not use computerised tomography routinely. Routine use of magnetic resonance imaging or dynamic flexion-extension fluoroscopy was rare, and few units regarded the latter as safe in unconscious patients. There was no consensus on when immobilisation of the cervical spine should be discontinued. Most centres that terminated immobilisation immediately after imaging did so on the basis of plain radiographs alone. Unconscious adult trauma patients remain at risk of inadequate assessment of potential cervical spine injuries.
Department of Anaesthesia, The Royal London Hospital, Whitechapel, London E1 1BB, UK. psjones@doctors.org.uk
P S
PS
Jones
J
J
Wadley
M
M
Healy
D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries*; D002985:Clinical Protocols; D003955:Diagnostic Tests, Routine; D019538:Health Care Surveys; D006801:Humans; D007103:Immobilization; D011364:Professional Practice / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014474:Unconsciousness / Q000150:complications*; D006113:United Kingdom