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Sun Oct 9 19:25:49 BST 2005

In a message dated 10/9/2005 12:02:53 P.M. Eastern Daylight Time,  
sumieb at compuserve.com writes:

for
> cross table c-spine.
>
> Gets read as normal by  EDP and/or radiologist.  Rad tech is told to remove
> the collar  for the AP and odontoid views but then to put the collar back
on
>  before coming back to ED.
>
> My position is that once the collar  is off why put it back on and if we
are
> putting it back on why are  we allowing it to be removed in the first
> place???
>
> Any  takers?
>
> Andrew Bowman
>

There seems to be a bit of confusion here--the c-collar should never be  
removed from a patient with c-spine tenderness OR from one who is  
unevaluable--ever.  See EAST guidelines--this is a completely agreed upon  consensus in the 
literature, no controversy at all.  Imaging of any sort by  itself does NOT 
clear the c-spine, only a phys exam showing no neck  tenderness can do that once 
the x-rays are cleared.  One exception to that  is the prolonged unevaluable 
patient, in whom there is no agreement, but many  now remove collar in that 
instance when phys exam is impossible after a week or  more with a 90 degree 
uprite film showing no instability after bone imaging is  normal.  Others use MRI 
in that case
One other point--it is pretty clear now from every study on this topic in  
the last 4 years, especially after a recent meta-analysis in the J of Trauma,  
that plain films are on their way to obsolescence, if not there already for  
those who have not yet gotten the message--you really should convert to CT for  
radiologic imaging to exclude c-spine injury--as many as 50% of injuries are  
missed by plain films.  This also goes for T and L spine evaluation.   Same 
principles go for clearance of the collar, though.
ERF

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