Cervical spine clearance - Revision history

Ostermayer: /* Criteria Not Met */

2020-09-09T20:43:29Z

Criteria Not Met

← Revisión anterior		Revisión del 20:43 9 sep 2020
Línea 28:		Línea 28:
	**For significant injury CT has a sensitivity of 100% while xray has a sensitivity 36%<ref> Bailitz J, Starr F, Beecroft M, et al. CT should replace three view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison. J Trauma. 2009;66:1605e1609.</ref>		**For significant injury CT has a sensitivity of 100% while xray has a sensitivity 36%<ref> Bailitz J, Starr F, Beecroft M, et al. CT should replace three view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison. J Trauma. 2009;66:1605e1609.</ref>
	*If negative CT for boney injury may clear spine unless<ref>Inaba, K et al.Cervical spinal clearance: a prospective Western Trauma Association multi-institutional trial.J Trauma Acute Care Surg. 2016 Dec; 81(6):1122-1130.</ref>		*If negative CT for boney injury may clear spine unless<ref>Inaba, K et al.Cervical spinal clearance: a prospective Western Trauma Association multi-institutional trial.J Trauma Acute Care Surg. 2016 Dec; 81(6):1122-1130.</ref>
	**Patient Altered ([[Cervical_spine_clearance#Altered_Patient\|see below]])<ref>Martin MJ, Bush LD, Inaba K, et al. Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey.J Trauma Acute Care Surg. 2017;83(6):1032-1040.</ref>		**'''Patient Altered''' ([[Cervical_spine_clearance#Altered_Patient\|see below]])<ref>Martin MJ, Bush LD, Inaba K, et al. Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey.J Trauma Acute Care Surg. 2017;83(6):1032-1040.</ref>
	**Neurologic abnormalities<ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma A cute Care Surg. 2015 Feb;78(2):430-41.</ref>		**'''Neurologic abnormalities'''<ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma A cute Care Surg. 2015 Feb;78(2):430-41.</ref>

	===Altered Patient===		===Altered Patient===

Ostermayer: /* Criteria Not Met */

2020-09-09T20:43:04Z

Criteria Not Met

← Revisión anterior		Revisión del 20:43 9 sep 2020
Línea 26:		Línea 26:
	*If unable to be cleared by CCSR or NEXUS then imaging is indicated with CT C-spine is indicated		*If unable to be cleared by CCSR or NEXUS then imaging is indicated with CT C-spine is indicated
	**CT recommended over xray		**CT recommended over xray
	**For significant injury CT has a sensitivity of 100% while xray has a sensitivity 36%<ref> Bailitz J, Starr F, Beecroft M, et al. CT should replace three view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison. J Trauma. 2009;66:1605e1609. </ref>		**For significant injury CT has a sensitivity of 100% while xray has a sensitivity 36%<ref> Bailitz J, Starr F, Beecroft M, et al. CT should replace three view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison. J Trauma. 2009;66:1605e1609.</ref>
	*If negative CT for boney injury		*If negative CT for boney injury may clear spine unless<ref>Inaba, K et al.Cervical spinal clearance: a prospective Western Trauma Association multi-institutional trial.J Trauma Acute Care Surg. 2016 Dec; 81(6):1122-1130.</ref>
	may clear spine unless<ref>~~naba~~, K et al.Cervical spinal clearance: a prospective Western Trauma Association multi-institutional trial.J Trauma Acute Care Surg. 2016 Dec; 81(6):1122-1130.</ref><ref>Martin MJ, Bush LD, Inaba K, et al. Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey.J Trauma Acute Care Surg. 2017;83(6):1032-1040.</ref><ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern ~~Associati on~~ for the Surgery of Trauma. J Trauma A cute Care Surg. 2015 Feb;78(2):430-41.</ref>		**Patient Altered ([[Cervical_spine_clearance#Altered_Patient\|see below]])<ref>Martin MJ, Bush LD, Inaba K, et al. Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey.J Trauma Acute Care Surg. 2017;83(6):1032-1040.</ref>
	**Patient Altered ([[Cervical_spine_clearance#Altered_Patient\|see below]])		**Neurologic abnormalities<ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma A cute Care Surg. 2015 Feb;78(2):430-41.</ref>
	**Neurologic abnormalities

	===Altered Patient===		===Altered Patient===

Ostermayer: /* Criteria Not Met */

2020-09-09T20:41:47Z

Criteria Not Met

← Revisión anterior		Revisión del 20:41 9 sep 2020
Línea 29:		Línea 29:
	*If negative CT for boney injury		*If negative CT for boney injury
	may clear spine unless<ref>naba, K et al.Cervical spinal clearance: a prospective Western Trauma Association multi-institutional trial.J Trauma Acute Care Surg. 2016 Dec; 81(6):1122-1130.</ref><ref>Martin MJ, Bush LD, Inaba K, et al. Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey.J Trauma Acute Care Surg. 2017;83(6):1032-1040.</ref><ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Associati on for the Surgery of Trauma. J Trauma A cute Care Surg. 2015 Feb;78(2):430-41.</ref>		may clear spine unless<ref>naba, K et al.Cervical spinal clearance: a prospective Western Trauma Association multi-institutional trial.J Trauma Acute Care Surg. 2016 Dec; 81(6):1122-1130.</ref><ref>Martin MJ, Bush LD, Inaba K, et al. Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey.J Trauma Acute Care Surg. 2017;83(6):1032-1040.</ref><ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Associati on for the Surgery of Trauma. J Trauma A cute Care Surg. 2015 Feb;78(2):430-41.</ref>
			**Patient Altered ([[Cervical_spine_clearance#Altered_Patient\|see below]])
			**Neurologic abnormalities

	===Altered Patient===		===Altered Patient===

Ostermayer: /* Criteria Not Met */

2020-09-09T20:41:30Z

Criteria Not Met

← Revisión anterior		Revisión del 20:41 9 sep 2020
Línea 29:		Línea 29:
	*If negative CT for boney injury		*If negative CT for boney injury
	may clear spine unless<ref>naba, K et al.Cervical spinal clearance: a prospective Western Trauma Association multi-institutional trial.J Trauma Acute Care Surg. 2016 Dec; 81(6):1122-1130.</ref><ref>Martin MJ, Bush LD, Inaba K, et al. Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey.J Trauma Acute Care Surg. 2017;83(6):1032-1040.</ref><ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Associati on for the Surgery of Trauma. J Trauma A cute Care Surg. 2015 Feb;78(2):430-41.</ref>		may clear spine unless<ref>naba, K et al.Cervical spinal clearance: a prospective Western Trauma Association multi-institutional trial.J Trauma Acute Care Surg. 2016 Dec; 81(6):1122-1130.</ref><ref>Martin MJ, Bush LD, Inaba K, et al. Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey.J Trauma Acute Care Surg. 2017;83(6):1032-1040.</ref><ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Associati on for the Surgery of Trauma. J Trauma A cute Care Surg. 2015 Feb;78(2):430-41.</ref>

	~~##Neurologic abnormalities~~

	===Altered Patient===		===Altered Patient===

Ostermayer: /* Criteria Not Met */

2020-09-09T20:41:11Z

Criteria Not Met

← Revisión anterior		Revisión del 20:41 9 sep 2020
Línea 29:		Línea 29:
	*If negative CT for boney injury		*If negative CT for boney injury
	may clear spine unless<ref>naba, K et al.Cervical spinal clearance: a prospective Western Trauma Association multi-institutional trial.J Trauma Acute Care Surg. 2016 Dec; 81(6):1122-1130.</ref><ref>Martin MJ, Bush LD, Inaba K, et al. Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey.J Trauma Acute Care Surg. 2017;83(6):1032-1040.</ref><ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Associati on for the Surgery of Trauma. J Trauma A cute Care Surg. 2015 Feb;78(2):430-41.</ref>		may clear spine unless<ref>naba, K et al.Cervical spinal clearance: a prospective Western Trauma Association multi-institutional trial.J Trauma Acute Care Surg. 2016 Dec; 81(6):1122-1130.</ref><ref>Martin MJ, Bush LD, Inaba K, et al. Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey.J Trauma Acute Care Surg. 2017;83(6):1032-1040.</ref><ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Associati on for the Surgery of Trauma. J Trauma A cute Care Surg. 2015 Feb;78(2):430-41.</ref>
	~~##Patient Altered ([[Cervical_spine_clearance#Altered_Patient\|see below]])~~
	##Neurologic abnormalities		##Neurologic abnormalities

Ostermayer: /* Criteria Not Met */

2020-09-09T20:40:30Z

Criteria Not Met

← Revisión anterior		Revisión del 20:40 9 sep 2020
Línea 29:		Línea 29:
	*If negative CT for boney injury		*If negative CT for boney injury
	may clear spine unless<ref>naba, K et al.Cervical spinal clearance: a prospective Western Trauma Association multi-institutional trial.J Trauma Acute Care Surg. 2016 Dec; 81(6):1122-1130.</ref><ref>Martin MJ, Bush LD, Inaba K, et al. Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey.J Trauma Acute Care Surg. 2017;83(6):1032-1040.</ref><ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Associati on for the Surgery of Trauma. J Trauma A cute Care Surg. 2015 Feb;78(2):430-41.</ref>		may clear spine unless<ref>naba, K et al.Cervical spinal clearance: a prospective Western Trauma Association multi-institutional trial.J Trauma Acute Care Surg. 2016 Dec; 81(6):1122-1130.</ref><ref>Martin MJ, Bush LD, Inaba K, et al. Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey.J Trauma Acute Care Surg. 2017;83(6):1032-1040.</ref><ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Associati on for the Surgery of Trauma. J Trauma A cute Care Surg. 2015 Feb;78(2):430-41.</ref>
	**Patient Altered ([[Cervical_spine_clearance#Altered_Patient\|see below]])		##Patient Altered ([[Cervical_spine_clearance#Altered_Patient\|see below]])
	**Neurologic abnormalities		##Neurologic abnormalities

	===Altered Patient===		===Altered Patient===

Ostermayer: /* Criteria Not Met */

2020-09-09T20:40:06Z

Criteria Not Met

← Revisión anterior		Revisión del 20:40 9 sep 2020
Línea 28:		Línea 28:
	**For significant injury CT has a sensitivity of 100% while xray has a sensitivity 36%<ref> Bailitz J, Starr F, Beecroft M, et al. CT should replace three view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison. J Trauma. 2009;66:1605e1609. </ref>		**For significant injury CT has a sensitivity of 100% while xray has a sensitivity 36%<ref> Bailitz J, Starr F, Beecroft M, et al. CT should replace three view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison. J Trauma. 2009;66:1605e1609. </ref>
	*If negative CT for boney injury		*If negative CT for boney injury
	may clear spine unless:<ref>naba, K et al.Cervical spinal clearance: a prospective Western Trauma Association multi-institutional trial.J Trauma Acute Care Surg. 2016 Dec; 81(6):1122-1130.</ref><ref>Martin MJ, Bush LD, Inaba K, et al. Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey.J Trauma Acute Care Surg. 2017;83(6):1032-1040.</ref><ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Associati on for the Surgery of Trauma. J Trauma A cute Care Surg. 2015 Feb;78(2):430-41.</ref>		may clear spine unless<ref>naba, K et al.Cervical spinal clearance: a prospective Western Trauma Association multi-institutional trial.J Trauma Acute Care Surg. 2016 Dec; 81(6):1122-1130.</ref><ref>Martin MJ, Bush LD, Inaba K, et al. Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey.J Trauma Acute Care Surg. 2017;83(6):1032-1040.</ref><ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Associati on for the Surgery of Trauma. J Trauma A cute Care Surg. 2015 Feb;78(2):430-41.</ref>
	**Patient Altered ([[Cervical_spine_clearance#Altered_Patient\|see below]])		**Patient Altered ([[Cervical_spine_clearance#Altered_Patient\|see below]])
	**Neurologic abnormalities		**Neurologic abnormalities

Ostermayer: /* Criteria Not Met */

2020-09-09T20:38:33Z

Criteria Not Met

← Revisión anterior		Revisión del 20:38 9 sep 2020
Línea 29:		Línea 29:
	*If negative CT for boney injury		*If negative CT for boney injury
	may clear spine unless:<ref>naba, K et al.Cervical spinal clearance: a prospective Western Trauma Association multi-institutional trial.J Trauma Acute Care Surg. 2016 Dec; 81(6):1122-1130.</ref><ref>Martin MJ, Bush LD, Inaba K, et al. Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey.J Trauma Acute Care Surg. 2017;83(6):1032-1040.</ref><ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Associati on for the Surgery of Trauma. J Trauma A cute Care Surg. 2015 Feb;78(2):430-41.</ref>		may clear spine unless:<ref>naba, K et al.Cervical spinal clearance: a prospective Western Trauma Association multi-institutional trial.J Trauma Acute Care Surg. 2016 Dec; 81(6):1122-1130.</ref><ref>Martin MJ, Bush LD, Inaba K, et al. Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey.J Trauma Acute Care Surg. 2017;83(6):1032-1040.</ref><ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Associati on for the Surgery of Trauma. J Trauma A cute Care Surg. 2015 Feb;78(2):430-41.</ref>
	*Patient Altered ([[Cervical_spine_clearance#Altered_Patient\|see below]])		**Patient Altered ([[Cervical_spine_clearance#Altered_Patient\|see below]])
	*Neurologic abnormalities		**Neurologic abnormalities

	===Altered Patient===		===Altered Patient===

Ostermayer: /* Criteria Not Met */

2020-09-09T20:36:15Z

Criteria Not Met

← Revisión anterior		Revisión del 20:36 9 sep 2020
Línea 29:		Línea 29:
	*If negative CT for boney injury		*If negative CT for boney injury
	may clear spine unless:<ref>naba, K et al.Cervical spinal clearance: a prospective Western Trauma Association multi-institutional trial.J Trauma Acute Care Surg. 2016 Dec; 81(6):1122-1130.</ref><ref>Martin MJ, Bush LD, Inaba K, et al. Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey.J Trauma Acute Care Surg. 2017;83(6):1032-1040.</ref><ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Associati on for the Surgery of Trauma. J Trauma A cute Care Surg. 2015 Feb;78(2):430-41.</ref>		may clear spine unless:<ref>naba, K et al.Cervical spinal clearance: a prospective Western Trauma Association multi-institutional trial.J Trauma Acute Care Surg. 2016 Dec; 81(6):1122-1130.</ref><ref>Martin MJ, Bush LD, Inaba K, et al. Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey.J Trauma Acute Care Surg. 2017;83(6):1032-1040.</ref><ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Associati on for the Surgery of Trauma. J Trauma A cute Care Surg. 2015 Feb;78(2):430-41.</ref>
	*Patient Altered (see below)		*Patient Altered ([[Cervical_spine_clearance#Altered_Patient\|see below]])
	*Neurologic abnormalities		*Neurologic abnormalities

Ostermayer: /* Obtunded Patient */

2020-09-09T20:35:34Z

Obtunded Patient

← Revisión anterior		Revisión del 20:35 9 sep 2020
Línea 32:		Línea 32:
	*Neurologic abnormalities		*Neurologic abnormalities

	===~~Obtunded~~ Patient===		===Altered Patient===
	*EAST (Eastern Association for the Surgery of Trauma) performed systematic review in 2015<ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2015 Feb;78(2):430-41</ref>		*EAST (Eastern Association for the Surgery of Trauma) performed systematic review in 2015<ref>Patel MB, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2015 Feb;78(2):430-41</ref>
	**Review included 1800 obtunded patients generally defined as GCS<13 with negative CT c-spine using <3mm axial cuts		**Review included 1800 obtunded patients generally defined as GCS<13 with negative CT c-spine using <3mm axial cuts