title: Cervical spine clearance protocols in Level I, II, and III trauma centers in California.
abstract: BACKGROUND
  Cervical spine clearance protocols were developed to standardize the clearance of the cervical spine after blunt trauma and prevent secondary neurologic injuries. The degree of incorporation of evidence-based guidelines into protocols at trauma centers in California is unknown.
  
  
  OBJECTIVE
  To evaluate the cervical spine clearance protocols in all trauma centers of California.
  
  
  METHODS
  An observational cross-sectional study.
  
  
  METHODS
  Included from Level I, II, III trauma centers in California.
  
  
  METHODS
  The self-reported outcomes of each trauma center's cervical spine clearance protocols were assessed.
  
  
  METHODS
  Level I (n=15), II (n=30), and III (n=11) trauma centers in California were contacted. Each available protocol was reviewed for four scenarios: clearing the asymptomatic patient, the initial imaging modality used in patients not amenable to clinical clearance, and the management strategies for patients with persistent neck pain with a negative computed tomography (CT) scan and those who are obtunded. Results were compared with the 2009 Eastern Association for the Surgery of Trauma (EAST) cervical spine clearance guidelines.
  
  
  RESULTS
  The response rate was 96%. Sixty-three percent of California's trauma centers (Level I, 93%; Level II, 60%; Level III, 27%) had written cervical spine clearance protocols. For asymptomatic patients, 83% of Level I and 61% of Level II centers used National Emergency X-Radiography Utilization Study criteria with/without painless range of motion. For those requiring imaging, 67% of Level I and 56% of Level II centers stated a CT scan should be the first line of imaging. For obtunded patients and patients with persistent neck pain and a negative CT scan, more than 90% of Level I and more than 70% of Level II trauma centers incorporated the 2009 EAST recommendations. No institution recommended passive flexion-extension radiographs for the obtunded patient.
  
  
  CONCLUSIONS
  Written cervical spine clearance protocols exist in 63% of California's trauma centers and only 51% of the centers have protocols that follow current evidence-based guidelines. Standardization and utilization of these protocols should be encouraged to prevent missed injuries and secondary neurologic injuries.
authors.affiliation: Department of Orthopaedic surgery, Orthopaedic Trauma Institute, University of California-San Francisco (UCSF)/San Francisco General Hospital (SFGH), 2550 23rd St, Bldg 9, 2nd Floor, San Francisco, CA 94110, USA. Electronic address: PekmezciM@orthosurg.ucsf.edu.
authors.forename: Murat
authors.initials: M
authors.lastname: Pekmezci
authors.affiliation: Department of Orthopaedic surgery, Orthopaedic Trauma Institute, University of California-San Francisco (UCSF)/San Francisco General Hospital (SFGH), 2550 23rd St, Bldg 9, 2nd Floor, San Francisco, CA 94110, USA.
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Theologis
authors.affiliation: Department of Orthopaedic surgery, Orthopaedic Trauma Institute, University of California-San Francisco (UCSF)/San Francisco General Hospital (SFGH), 2550 23rd St, Bldg 9, 2nd Floor, San Francisco, CA 94110, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Dionisio
authors.affiliation: Department of General Surgery, UCSF, SFGH, 1001 Potrero Ave, Rm 3A12, San Francisco, CA 94143, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Mackersie
authors.affiliation: Department of Orthopaedic surgery, Orthopaedic Trauma Institute, University of California-San Francisco (UCSF)/San Francisco General Hospital (SFGH), 2550 23rd St, Bldg 9, 2nd Floor, San Francisco, CA 94110, USA.
authors.forename: R Trigg
authors.initials: RT
authors.lastname: McClellan
mesh_terms: D002140:California; D002574:Cervical Vertebrae / Q000293:injuries*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011859:Radiography; D016059:Range of Motion, Articular; D012015:Reference Standards; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000000981:diagnostic imaging* / Q000628:therapy; D014193:Trauma Centers / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices
keywords: Blunt trauma; California; Cervical spine; Cervical spine CT scan; Clearance protocols; NEXUS