The optimal method of clearing the cervical spine in obtunded trauma patients is unclear.
Computed tomography (CT) identifies most injuries but may miss ligamentous injuries. Magnetic
resonance (MR) imaging has been widely used to exclude ligamentous injuries. We postulate
that with the new generation of CT scanners, MR imaging is not needed to rule out significant
injuries. Our protocol for clearing the cervical spine in obtunded trauma patients depends on
CT alone. We are prospectively following these patients and performing a clinical examination
when they are awake to show this is a safe approach.
All OBTPs with gross movement of all four extremities admitted to MetroHealth Medical Center
(MHMC), the regional Level I Trauma Center in Cleveland OH, who underwent a CT CS at MHMC
between October 2006 and September 2008 will be included. Prospective data will be collected
on these patients including age, gender, mechanism of injury, Glasgow Coma Scale (GCS) on
admission, results of CT CS, GCS at the time of collar clearance, day of collar clearance,
collar complications, date of reexamination, and results of reexamination. We will define an
obtunded patient as a patient who was unable to reliably describe the presence or absence of
CS symptoms in the opinion of the examining physician. Patients needed to have gross movement
of all four extremities to be included in the study; if they did not, they were excluded. The
presence or lack of sensory examination was not evaluated for the purposes of this study. We
will define cervical collar complications as skin breakdown identified either by the skin
care team during weekly rounds in the intensive care unit or by the treating physician at any
- Subjects will include all patients (including children) after blunt trauma in whom
cervical spine injury has not been ruled out admitted to MetroHealth Medical Center
- We are excluding patients with an obvious neurologic deficit attributable to the
- We are excluding patients with abnormalities of the cervical spine that are identified
on either plain films or CT.
- We are also excluding those patients in whom the cervical spine can be cleared
clinically due to normal mental status.