Evaluation of the acute cervical spine: A management algorithm

Background: Safe, efficient, and cost-effective evaluation of the spine is the goal in the trauma setting. At our Level I trauma facility, the trauma service, emergency medicine, radiology, anesthesia, and the spine service c ombined individual concerns into one agreed-upon clearance protocol. Here, we present the effectiveness of a new cervical spine clearance protocol. Methods: A retrospective review was initiated of all trauma patients evalua ted in a Level I trauma center the year before and after implementation of a new cervical spine protocol to determine the incidence of missed cervical injuries. An additional 6 months were reviewed to detect any missed injuri es late in the study period. Results: During the 2-year study period, 4,460 patients presented to the em ergency room with some form of cervical spine precautions. Blunt trauma com prised 90% of the study population, According to the protocol, approximatel y 45% required further cervical radiographs after presentation. In the prep rotocol year, 77 of 2,217 (3.4%) patients were diagnosed with cervical spin e injuries, 16 of 77 (21%) with multiple level of injuries, and 25 of 77 (3 2%) with neurologic compromise. Three of 2,217 patients had missed cervical spine injuries on their initial evaluations. In the postprotocol year, 84 of 2,243 (3.4%) patients had cervical injuries, 25 of 84 (30%) with multipl e levels of injuries and 28 of 84 (28%) with neurologic compromise. No pati ent evaluated during the protocol year was missed. All statistics between t he two groups were not significant. Conclusion: The current protocol by risk stratifying patients on presentati on is effective In assessing patients for cervical spine injuries.