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C-spine clearance

Dr Juan H Klopper trauma-list@trauma.org
Mon, 28 Apr 2003 20:32:48 +0200


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Dr Frykberg,

Thanks for the reply.  I know the guidelines you mentioned well and have 
amongst many other sources included it in a 500 page "guidelines paper" 
I wrote for our department recently.  It is because of this that my 
problems with Radiology started and I will use your and all other 
e-mails written on this list to try and get our Radiologists up to 
speed.  If all else fails I'll rent the same 747 mentioned by Ken Mattox 
and get Sal over here :-) .

Thanks again.

Juan H Klopper
Consultant Surgeon
Free State University
South Africa.

DocRickFry@aol.com wrote:

> In a message dated 4/26/2003 6:18:34 AM Eastern Daylight Time, 
> jrmk@mweb.co.za writes:
>
>> What I do want to as ask is whether their statement that they refuse 
>> full neck CT, due to the amount of radiation involved.  They refuse 
>> to budge from the fact that they will only CT the areas which show 
>> abnormality on X-ray review (AP and lateral only are taken) if 
>> unevaluable or in the case of a conscious patient, the areas of 
>> tenderness +- AP lateral X-rays abnormalities.
>>
>
>
> Well, a few points:
> First, IF you are going to use plain films as a screen, it is now well 
> established that a lateral, or the two views you use, are 
> worthless--do not at all accomplish what you want, i.e. screening for 
> injury, because they can miss too many.  You must at least do the 
> standard three views--AP, lateral and odontoid.
> Second--it is now becoming increasingly clear that CT of the full 
> c-spine far and away finds many more injuries than does plain films, 
> and several papers are now coming out all showing this.  We used to 
> have the same philosophy as your radiologists, but this should be 
> reconsidered.
> As a start if you want to acquaint yourself with the current 
> literature and consensus, try the EAST Practice Management Guidelines 
> at www.east.org.  Also on that website is a listing of the abstracts 
> from the 2003 EAST meeting, where you will find 5 papers dealing with 
> c-spine clearance that will be published later this year--all conclude 
> the same thing regarding CT vs plain films
> ERF



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Dr Frykberg,<br>
<br>
Thanks for the reply. &nbsp;I know the guidelines you mentioned well and have
amongst many other sources included it in a 500 page "guidelines paper" I
wrote for our department recently. &nbsp;It is because of this that my problems
with Radiology started and I will use your and all other e-mails written
on this list to try and get our Radiologists up to speed. &nbsp;If all else fails
I'll rent the same 747 mentioned by Ken Mattox and get Sal over here <span
 class="moz-smiley-s1"><span> :-) </span></span>.<br>
<br>
Thanks again.<br>
<br>
Juan H Klopper<br>
Consultant Surgeon<br>
Free State University<br>
South Africa.<br>
<br>
<a class="moz-txt-link-abbreviated" href="mailto:DocRickFry@aol.com">DocRickFry@aol.com</a> wrote:<br>
<blockquote type="cite" cite="mid1cc.82b1ceb.2bdbdc8a@aol.com"><font
 face="arial,helvetica"><font size="2" family="SANSSERIF" face="Arial"
 lang="0">In a message dated 4/26/2003 6:18:34 AM Eastern Daylight Time,
<a class="moz-txt-link-abbreviated" href="mailto:jrmk@mweb.co.za">jrmk@mweb.co.za</a> writes:<br>
 <br>
 
  <blockquote type="CITE"
 style="border-left: 2px solid rgb(0,0,255); margin-left: 5px; margin-right: 0px; padding-left: 5px;">What
I do want to as ask is whether their statement that they refuse full neck
CT, due to the amount of radiation involved.&nbsp; They refuse to budge from the
fact that they will only CT the areas which show abnormality on X-ray review
(AP and lateral only are taken) if unevaluable or in the case of a conscious
patient, the areas of tenderness +- AP lateral X-rays abnormalities.<br>
 <br>
 </blockquote>
  <br>
 <br>
 Well, a few points:<br>
 First, IF you are going to use plain films as a screen, it is now well established
that a lateral, or the two views you use, are worthless--do not at all accomplish
what you want, i.e. screening for injury, because they can miss too many.&nbsp;
You must at least do the standard three views--AP, lateral and odontoid.<br>
 Second--it is now becoming increasingly clear that CT of the full c-spine
far and away finds many more injuries than does plain films, and several
papers are now coming out all showing this.&nbsp; We used to have the same philosophy
as your radiologists, but this should be reconsidered.<br>
 As a start if you want to acquaint yourself with the current literature
and consensus, try the EAST Practice Management Guidelines at <a
 href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-April/"www.east.org">www.east.org</a>.&nbsp; Also on that website is a listing
of the abstracts from the 2003 EAST meeting, where you will find 5 papers
dealing with c-spine clearance that will be published later this year--all
conclude the same thing regarding CT vs plain films<br>
 ERF</font></font></blockquote>
<br>
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