Computed tomography for early and safe discontinuation of cervical spine immobilization in obtunded multiply injured patients.
BACKGROUND
Evaluation of the cervical spine (c-spine) in obtunded severely injured trauma patients is controversial, and spine immobilization is frequently prolonged. We examined the effect of two different c-spine evaluation protocols on c-spine immobilization and clinical outcomes.


METHODS
We prospectively evaluated consecutive intubated and mechanically ventilated patients admitted to the surgical intensive care unit (ICU) of a Level I academic trauma center with a diagnosis of multiple blunt injuries who had normal findings on high-resolution helical computed tomogram of C1 to T1 with reconstructions (HCTrecon). From July 1, 2003 to June 30, 2005 (n = 140), the findings of HCTrecon and either clinical examination or magnetic resonance imaging (MRI) were required to be normal to discontinue c-spine immobilization (clinical/MRI protocol). From July 1, 2005 to June 30, 2006 (n = 75), the policy was changed to require normal finding only on HCTrecon to discontinue c-spine immobilization (HCTrecon protocol).


RESULTS
Patients evaluated by the clinical/MRI and HCTrecon protocols had similar baseline characteristics. Compared with clinical/MRI patients, HCTrecon patients had their c-spines immobilized for fewer days (median, 6 days vs. 2 days; p < 0.001), were less likely to experience a complication of c-spine immobilization (64% vs. 37%, p = 0.010), required shorter periods of mechanical ventilation (median, 4 days vs. 3 days; p = 0.011), and had shorter stays in the ICU (median, 6 days vs. 4 days; p = 0.028) and hospital (median, 16 days vs. 14 days; p = 0.043). There was no difference in hospital mortality (13% vs. 16%, p = 0.920) and no missed c-spine injuries in either group.


CONCLUSIONS
Discontinuation of c-spine precautions based on the normal findings of HCTrecon decreases the duration of c-spine immobilization in obtunded severely injured patients and is associated with fewer complications, fewer days of mechanical ventilation, and shorter stays in the ICU and hospital.
Stelfox
Henry Thomas
HT
Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada. tom.stelfox@calgaryhealthregion.ca
Velmahos
George C
GC
Gettings
Elise
E
Bigatello
Luca M
LM
Schmidt
Ulrich
U
D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007103:Immobilization; D015601:Injury Severity Score; D007442:Intubation, Intratracheal; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging; D019838:Neck Injuries / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging