title: Cervical spine clearance protocols in level 1 trauma centers in the United States.
abstract: METHODS
  Observational, cross-sectional.
  
  
  OBJECTIVE
  To evaluate cervical spine clearance protocols in level 1 trauma centers in the United States.
  
  
  BACKGROUND
  Cervical spine clearance protocols were developed to prevent missed injuries that could result in neurological deficits. The degree of incorporation of evidence-based guidelines into protocols at trauma centers in the United States is unknown.
  
  
  METHODS
  Level 1 trauma (n = 191) centers in the United States were contacted. Each available protocol was reviewed for 4 scenarios: clearing the asymptomatic patient, the imaging used in patients not amenable to clinical clearance, the management strategies for patients with persistent neck pain with a negative computed tomographic (CT) scan, and those who are obtunded.
  
  
  RESULTS
  The response rate was 87%. Cervical spine clearance protocols existed in 57% of the institutions. National Emergency X-Radiography Utilization Study criteria to clear asymptomatic patients were recommended in 89% of protocols. Sixty percent of protocols used CT scans as the first line of imaging. In patients with persistent neck pain with negative CT scan flexion-extension plain radiographs were the most common (30%) next step for clearance. In patients who are obtunded, a CT scan followed by a magnetic resonance imaging was the most common method (31%) of clearance. Eight percent of the protocols recommended dynamic flexion-extension views in patients who are obtunded, which are contraindicated.
  
  
  CONCLUSIONS
  Written cervical spine clearance protocols exist in 57% of level 1 trauma centers in the United States. These protocols are highly variable and standardization and utilization of these protocols should be encouraged in all trauma centers to prevent missed injuries and neurological catastrophes.
  
  
  METHODS
  4.
authors.affiliation: From the Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, University of California-San Francisco (UCSF)/San Francisco General Hospital (SFGH), San Francisco, CA.
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Theologis
authors.forename: Robert
authors.initials: R
authors.lastname: Dionisio
authors.forename: Robert
authors.initials: R
authors.lastname: Mackersie
authors.forename: Robert Trigg
authors.initials: RT
authors.lastname: McClellan
authors.forename: Murat
authors.initials: M
authors.lastname: Pekmezci
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries*; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging; D019547:Neck Pain / Q000000981:diagnostic imaging; D017410:Practice Guidelines as Topic; D013124:Spinal Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D014481:United States