May 27, 2013

Guideline Title

Practice management guidelines for identification of cervical spine injuries following trauma: update from the Eastern Association for the Surgery of Trauma Practice Management Guidelines
Committee.

Bibliographic Source(s)

Como JJ, Diaz JJ, Dunham CM, Chiu WC, Duane TM, Capella JM, Holevar MR, Khwaja KA, Mayglothling JA, Shapiro MB, Winston ES. Practice management guidelines for identification of cervical spine injuries following trauma: update from the Eastern Association for the Surgery of Trauma practice management guidelines committee. J Trauma. 2009 Sep;67(3):651-9. [71 references] PubMed External Web Site Policy

Guideline Status

This is the current release of the guideline.
This guideline updates a previous version: Eastern Association for the Surgery of Trauma (EAST), Practice Parameter Workgroup for Cervical Spine Clearance. EAST practice management guidelines for trauma. Allentown (PA): Eastern Association for the Surgery of Trauma; 1998 Jan 23. Practice management guidelines for identifying cervical spine injuries following trauma. p. 33-49. [62 references]

2009 Sep;67(3):651-9. doi: 10.1097/TA.0b013e3181ae583b.

Practice management guidelines for identification of cervical spine injuries following trauma: update from the eastern association for the surgery of trauma practice management guidelines committee.

Como JJ, Diaz JJ, Dunham CM, Chiu WC, Duane TM, Capella JM, Holevar MR, Khwaja KA, Mayglothling JA, Shapiro MB, Winston ES.

Source

Division of Trauma, Critical Care, and Burns, Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA. jcomo@metrohealth.org

Abstract

BACKGROUND:

Injury to the cervical spine (CS) is common after major trauma. The Eastern Association for the Surgery of Trauma first published its Practice Management Guidelines for the evaluation of CS injury in 1998. A subsequent revision was published in 2000. Since that time a large volume of literature has been published. As a result, the Practice Management Guidelines Committee set out to develop updated guidelines for the identification of CS injury.

METHODS:

A search of the National Library of Medicine and the National Institutes of Health MEDLINE database was performed using PubMed (www.pubmed.gov). The search retrieved English language articles regarding the identification of CS injury from 1998 to 2007. The questions posed were: who needs CS imaging; what imaging should be obtained; when should computed tomography, magnetic resonance imaging, or flexion/extension radiographs be used; and how is significant ligamentous injury excluded in the comatose patient?

RESULTS:

Seventy-eight articles were identified. From this group, 52 articles were selected to construct the guidelines.

CONCLUSION:

There have been significant changes in practice since the previous CS injury guidelines. Most significantly, computed tomography has supplanted plain radiography as the primary screening modality in those who require imaging. Clinical clearance remains the standard in awake, alert patients with trauma without neurologic deficit or distracting injury who have no neck pain or tenderness with full range of motion. Cervical collars should be removed as soon as feasible. Controversy persists regarding CS clearance in the obtunded patient without gross neurologic deficit.