title: Cervical spine clearance in obtunded patients after blunt traumatic injury: a systematic review.
abstract: BACKGROUND
  Cervical spine clearance protocols are controversial for unconscious patients after blunt traumatic injury and negative findings on computed tomography (CT).
  
  
  OBJECTIVE
  To review evidence about the utility of different cervical spine clearance protocols in excluding significant cervical spine injury after negative CT results in obtunded adults with blunt traumatic injury.
  
  
  METHODS
  MEDLINE, EMBASE, CINAHL, Google Scholar, and the Cochrane Library were searched from January 2000 through November 2014.
  
  
  METHODS
  English-language studies that examined patients with negative CT results having confirmatory routine testing with magnetic resonance imaging (MRI), dynamic radiography, or clinical examination and that reported outcome measures of missed cervical spine injury, need for operative stabilization, or prolonged use of cervical collars.
  
  
  METHODS
  Independent reviewers evaluated the quality of studies and abstracted the data according to a predefined protocol.
  
  
  RESULTS
  Of 28 observational studies (3627 patients) that met eligibility criteria, 7 were prospective studies (1686 patients) with low risk of bias and well-interpreted, high-quality CT scans. These 7 studies showed that 0% of significant injuries were missed after negative CT results. The overall studies using confirmatory routine testing with MRI showed incidence rates of 0% to 1.5% for cervical spine instability (16 studies; 1799 patients), 0% to 7.3% for need for operative fixation (17 studies; 1555 patients), and 0% to 29.5% for prolonged collar use (16 studies; 1453 patients).
  
  
  CONCLUSIONS
  Most studies were retrospective. Approaches to management of soft tissue changes with collars varied markedly.
  
  
  CONCLUSIONS
  Cervical spine clearance in obtunded adults after blunt traumatic injury with negative results from a well-interpreted, high-quality CT scan is probably a safe and efficient practice.
  
  
  BACKGROUND
  None.
authors.forename: Jetan H
authors.initials: JH
authors.lastname: Badhiwala
authors.forename: Chung K
authors.initials: CK
authors.lastname: Lai
authors.forename: Waleed
authors.initials: W
authors.lastname: Alhazzani
authors.forename: Forough
authors.initials: F
authors.lastname: Farrokhyar
authors.forename: Farshad
authors.initials: F
authors.lastname: Nassiri
authors.forename: Maureen
authors.initials: M
authors.lastname: Meade
authors.forename: Alireza
authors.initials: A
authors.lastname: Mansouri
authors.forename: Niv
authors.initials: N
authors.lastname: Sne
authors.forename: Mohammed
authors.initials: M
authors.lastname: Aref
authors.forename: Naresh
authors.initials: N
authors.lastname: Murty
authors.forename: Christopher
authors.initials: C
authors.lastname: Witiw
authors.forename: Sheila
authors.initials: S
authors.lastname: Singh
authors.forename: Blake
authors.initials: B
authors.lastname: Yarascavitch
authors.forename: Kesava
authors.initials: K
authors.lastname: Reddy
authors.forename: Saleh A
authors.initials: SA
authors.lastname: Almenawer
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000473:pathology; D006801:Humans; D007103:Immobilization; D008279:Magnetic Resonance Imaging; D014057:Tomography, X-Ray Computed; D014474:Unconsciousness / Q000150:complications*; D014949:Wounds, Nonpenetrating / Q000150:complications*