My center is in the process of updating our cervical spine clearance protocols, and I wanted to share this work with you to help those who may be doing the same. Today, I’ll review our new clearance method for patients with normal mental status. Tomorrow I’ll go over the protocol for patients who are obtunded.
Here are the key points:
- Clinical clearance is acceptable except in patients with a high risk mechanism (see link to YouTube video below for clinical clearance technique)
- If risk factors are present or exam is abnormal, we use our Blunt Trauma Imaging Protocol to order the appropriate imaging study (see link below)
- If clearance efforts fail but radiographs are normal, upright plain images are obtained to evaluate stability
- Flexion/extension xrays are no longer used
- Patients with an abnormal exam but normal radiographs may be discharged with a soft collar and re-evaluated in a week.
Many of you know my opinion on soft collars (see link below). However, they do serve a purpose here. The protocol will demonstrate that if the patient potentially has an injury, it is stable. Unstable injuries will have been identified and referred to a spine specialist. The collar reminds the patient to voluntarily limit their neck motion to reasonable amounts until they are re-evaluated. And it is also inexpensive, does not lead to skin breakdown, and has much better patient compliance.