J. M. Tatum1, N. Melo1, A. Ko1, N. K. Dhillon1, M. W. Choi1, E. J. Smith1, D. A. Yim1, G. Barmparas1, E. J. Ley1 1Cedars-Sinai Medical Center,Division Of Trauma And Critical Care, Department Of Surgery,Los Angeles, CA, USA
Introduction: Routine spinal motion restriction after traumatic injury has been a mainstay of pre-hospital trauma care for over three decades. Recent guidelines recommend a selective approach with cervical spine clearance in the field when criteria are met.
Methods: In January, 2014 the Department of Health Services of the City of Los Angeles, California implemented revised guidelines for cervical spinal motion restriction after blunt mechanism trauma. Adult patients (≥18 years old) with an initial GCS of ≥13 presented to a single level I trauma center after blunt mechanism trauma over the following one-year period were retrospectively reviewed. Demographics, injury data, and pre-hospital data were collected. Cervical spine injury (CSI) was identified by ICD-9 codes.
Results: 1,111 patients were presented to the trauma center by emergency medical services after sustaining blunt mechanism trauma. Patients were excluded if they refused c-collar placement or if documentation was incomplete. A total of 997 patients with a documented evaluation were included in our analysis. Spinal motion restrictions were not implemented in 172 (17.2%) in accordance with the protocol. The rate of spinal cord injury among all patients was 2.2% (22/997) and 1.2% (2/172) in patients without spinal motion restrictions. The sensitivity and specificity of the protocol is 90.9% (95% CI: 69.4-98.4) and 17.4% (95% CI: 15.1-20.0), respectively, for cervical spine injury. Two patients with CSI (9.1%) arrived without immobilization, having met field clearance guidelines. Both were managed non-operatively and had no neurological compromise.
Conclusion: New guidelines for cervical spinal motion restriction have high sensitivity and low specificity to identify CSI. When patients with injuries were not placed on motion restrictions there were no negative clinical outcomes. A pre-hospital selective approach to implementing cervical spinal motion restriction is safe.
