Defining the cervical spine clearance algorithm: A single institution prospective study of over 9000 patients.

Background: Variability exists in the approach to cervical spine (c-spine) clearance after significant trauma. Utilizing concurrently gathered data on >9,000 such patients, the current study develops an evidence-based and readily adoptable algorithm for c-spine clearance aimed at timely removal of collar, optimal use of imaging and appropriate spine consultations. Methods: Prospective study of adult blunt trauma team alert (TTA) patients presenting at a Level-I trauma center who underwent screening CT to diagnose/rule-out c-spine injury (1/08-5/14). Regression analysis comparing patients with and without c-spine injury - fracture and/or ligament - was used to identify significant predictors of injury. The predictors with the highest odds ratio were utilized to develop the algorithm. Results: Among 9227 patients meeting inclusion criteria, c-spine injury was identified in 553 (5.99%). All 553 patients had a cervical spine fracture and of these, 57 patients (0.6% of entire population and 10.31% of patients with injury) also had a ligamentous injury. No patient with a normal CT was found to have an injury. The five greatest predictors of ligament injury - 1. CT evidence of ligament injury; 2. Fracture pattern 'not' isolated transverse/spinous process; 3. Neurologic symptoms; 4. Midline tenderness; and 5. GCS

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