Cervical spine clearance in obtunded patients after blunt traumatic injury: a systematic review

Annals of Internal Medicine
Jetan H BadhiwalaSaleh A Almenawer

Abstract

Cervical spine clearance protocols are controversial for unconscious patients after blunt traumatic injury and negative findings on computed tomography (CT). 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. MEDLINE, EMBASE, CINAHL, Google Scholar, and the Cochrane Library were searched from January 2000 through November 2014. 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. Independent reviewers evaluated the quality of studies and abstracted the data according to a predefined protocol. 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 confirmat...Continue Reading

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Citations

Apr 5, 2016·AJR. American Journal of Roentgenology·Daniel MascarenhasDeborah M Stein
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