Clearing the Cervical Spine in Patients with Distracting Injuries: An AAST Multi-Institutional Trial

Background Single institution studies have shown that clinical examination of the cervical spine (c-spine) is sensitive for clearance of the c-spine in blunt trauma patients with distracting injuries. Despite an unclear definition, most trauma centers still adhere to the notion that distracting injuries adversely affect the sensitivity of c-spine clinical examination. A prospective AAST multi-institutional trial was performed to assess the sensitivity of clinical examination screening of the c-spine in awake and alert blunt trauma patients with distracting injuries. Methods During the 42-month study period, blunt trauma patients 18 years and older were prospectively evaluated with a standard c-spine examination protocol at 8 Level 1 trauma centers. Clinical examination was performed regardless of the presence of distracting injuries. Patients without complaints of neck pain, tenderness or pain on range of motion were considered to have a negative c-spine clinical examination. All patients with positive or negative c-spine clinical examination underwent computed tomography (CT) scan of the entire c-spine. Clinical examination findings were documented prior to the CT scan. Results During the study period, 2929 patients were entered. At least one distracting injury was diagnosed in 70% of the patients. A c-spine injury was found on CT scan in 7.6% of the patients. There was no difference in the rate of missed injury when comparing patients with a distracting injury to those without a distracting injury (10.4% vs 12.6%, p=0.601). Only one injury missed by clinical examination underwent surgical intervention and none had a neurological complication. Conclusions Negative clinical exam may be sufficient to clear the cervical spine in awake and alert blunt trauma patients, even in the presence of a distracting injury. These findings suggest a potential source for improvement in resource utilization. Level of Evidence Level 3, Diagnostic Test To be presented as a podium presentation at the 77st Annual Meeting of the American Association for the Surgery of Trauma and Clinical Congress of Acute Care Surgery, September 26-29, 2018 in San Diego, CA Conflicts of Interest and Financial Disclosures: None of the authors has anything to disclose Corresponding Author: Richard Gonzalez MD, 2160 S. First Ave, Maywood IL 60153, Office: 708-327-2072; Fax: 708-327-3474, Email: richard.gonzalez@lumc.edu © 2018 Lippincott Williams & Wilkins, Inc.

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