title: An evidence-based medicine process to determine outcomes after cervical spine trauma: what surgeons should be telling their patients.
abstract: METHODS
  A systematic review of the available medical literature from 1980 to 2010 was conducted and combined with expert opinion from a recent survey of experts regarding cervical spine fractures. Using an objective, hierarchical approach, the best available evidence is presented for health-related quality-of-life outcomes for these injuries.
  
  
  OBJECTIVE
  To provide an evidence-based set of guidelines for cervical spine injuries in order to reduce variability in the information given to patients and their families.
  
  
  BACKGROUND
  Patients' expectations regarding quality-of-life outcomes are highly dependent on the information provided by surgeons early in the treatment course. Our previous work has demonstrated that there is substantial variability in what surgeons tell patients regarding outcomes of cervical spine injuries, thus patients' expectations will differ and outcomes vary.
  
  
  METHODS
  Four common cervical spine injuries (C1 burst, Hangman fracture, odontoid fracture, and unilateral facet fracture) treated both surgically and nonsurgically were considered. We assessed the evidence regarding 5 health-related quality-of-life outcomes: time to return to work, activity level, hospital stay, the proportion of patients who are pain free and patients who have regained full range of motion at 1 year after the injury.
  
  
  RESULTS
  Published outcome data were available for most injuries. Using consensus expert opinion and the literature, answers to each question were achieved. Overall, expert opinion was relatively homogeneous across injury types, suggesting that experts do not distinguish between specific injuries when advising patients of expected outcomes such as pain.
  
  
  CONCLUSIONS
  By overcoming gaps in the literature with consensus expert opinion, our study provides surgeons and others with evidence-based medicine guidelines for patient-centered outcomes after cervical spine injury. This information can be presented to patients to frame expectations of typical outcomes during and after treatment to optimize patient care and quality of life.
authors.affiliation: Division of Orthopaedics, Department of Surgery, University of Calgary, Calgary, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Lewkonia
authors.forename: Christian
authors.initials: C
authors.lastname: Dipaola
authors.forename: Rowan
authors.initials: R
authors.lastname: Schouten
authors.forename: Vanessa
authors.initials: V
authors.lastname: Noonan
authors.forename: Marcel
authors.initials: M
authors.lastname: Dvorak
authors.forename: Charles
authors.initials: C
authors.lastname: Fisher
mesh_terms: D002574:Cervical Vertebrae / Q000293:injuries* / Q000601:surgery; D019317:Evidence-Based Medicine; D006801:Humans; D010817:Physician-Patient Relations; D011788:Quality of Life; D016103:Spinal Fractures / Q000209:etiology* / Q000601:surgery; D013124:Spinal Injuries / Q000150:complications* / Q000601:surgery; D016896:Treatment Outcome