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C-spine clearance

meredith mcbride trauma-list@trauma.org
Thu, 24 Apr 2003 18:25:15 -0700 (PDT)


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Ah, great. Thanks for the clarification. Indeed I did not know that full c-spine CT was inadequate for clearance in the early post-injury period. In comatose patients, we often immediately discontinue c-spine precautions following negative neck CT in order to augment positioning for craniotomy, to simplify nursing care, and so forth. Now, you do mention concensus opinion, which is helpful. But are there data to demonstrate that this approach would be contraindicated? It seems as though the data about CT concludes no missed injuries - ligamentous or otherwise. It's worthwhile to sort this out, as obtaining additional imaging - MRI or flexion/extension films - brings its own set of difficulties and limitations in the critical care setting. Certainly if I can continue to avoid adding those tests and yet practice a safe approach in this scenario, I'd like to do so.
DocRickFry@aol.com wrote:NO imaging test, regardless of what you use, in and of itself EXCLUDES c-spine injury reliably enough to allow removing the collar just on that basis, at least in the early postinjury period.  THAT is not disputed (see EAST Practice Managment Guidelines)--perhaps you are not aware of this? ...The consensus is quite clear that even CT does not provide enough info as to ligamentous instability. 


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<DIV>Ah, great. Thanks for the clarification. Indeed I did not know that full c-spine CT was inadequate for clearance in the early post-injury period. In comatose patients, we&nbsp;often immediately discontinue c-spine precautions following negative neck CT in order to augment positioning for craniotomy, to simplify nursing care, and so forth.</DIV>
<DIV>&nbsp;</DIV>
<DIV>Now, you do mention concensus opinion, which is helpful. But are there data to demonstrate that this approach would be contraindicated? It seems as though the data about CT concludes no missed injuries - ligamentous or otherwise.</DIV>
<DIV>&nbsp;</DIV>
<DIV>It's worthwhile to sort this out, as obtaining additional imaging - MRI or flexion/extension films - brings its own set of difficulties and limitations in the critical care setting. Certainly if I can continue to avoid adding those tests and yet practice a safe approach in this scenario, I'd like to do so.</DIV>
<DIV><BR><B><I>DocRickFry@aol.com</I></B> wrote:</DIV>
<BLOCKQUOTE style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #1010ff 2px solid"><FONT face=arial,helvetica><FONT lang=0 face=Arial size=2 FAMILY="SANSSERIF">NO imaging test, regardless of what you use, in and of itself EXCLUDES c-spine injury reliably enough to allow removing the collar just on that basis, at least in the early postinjury period.&nbsp; THAT is not disputed (see EAST Practice Managment Guidelines)--perhaps you are not aware of this?&nbsp;...The consensus is quite clear that even CT does not provide enough info as to ligamentous instability.</FONT> </BLOCKQUOTE></FONT><p><br><hr size=1>Do you Yahoo!?<br>
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