Defining the cervical spine clearance algorithm: A single-institution prospective study of more than 9,000 patients
Variability exists in the approach to cervical spine (c-spine) clearance after significant trauma. Using concurrently gathered data on more than 9,000 such patients, the current study develops an evidence-based and readily adoptable algorithm for c-spine clearance aimed at timely removal of collar,...
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| Veröffentlicht in: | The journal of trauma and acute care surgery 2016-09, Vol.81 (3), p.541-547 |
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| container_title | The journal of trauma and acute care surgery |
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| creator | Duane, Therese M Young, Andrew J Vanguri, Poornima Wolfe, Luke G Katzen, Judith Han, Jinfeng Mayglothling, Julie Whelan, James F Aboutanos, Michel B Ivatury, Rao R Malhotra, Ajai K |
| description | Variability exists in the approach to cervical spine (c-spine) clearance after significant trauma. Using concurrently gathered data on more than 9,000 such patients, the current study develops an evidence-based and readily adoptable algorithm for c-spine clearance aimed at timely removal of collar, optimal use of imaging, and appropriate spine consultations.
Prospective study of adult blunt trauma team alert (TTA) patients presenting at a Level I trauma center who underwent screening computed tomography (CT) to diagnose/rule out c-spine injury (January 2008 to May 2014). Regression analysis comparing patients with and without c-spine injury-fracture and/or ligament-was used to identify significant predictors of injury. The predictors with the highest odds ratio were used to develop the algorithm.
Among 9,227 patients meeting inclusion criteria, c-spine injury was identified in 553 patients (5.99%). All 553 patients had a c-spine fracture, and of these, 57 patients (0.6% of entire population and 10.31% of patients with injury) also had a ligamentous injury. No patient with a normal CT result was found to have an injury. The five greatest predictors of ligament injury that follow were used to develop the algorithm: (1) CT evidence of ligament injury; (2) fracture pattern "not" isolated transverse/spinous process; (3) neurologic symptoms; (4) midline tenderness; and (5) Glasgow Coma Scale score |
| doi_str_mv | 10.1097/TA.0000000000001151 |
| format | Article |
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Prospective study of adult blunt trauma team alert (TTA) patients presenting at a Level I trauma center who underwent screening computed tomography (CT) to diagnose/rule out c-spine injury (January 2008 to May 2014). Regression analysis comparing patients with and without c-spine injury-fracture and/or ligament-was used to identify significant predictors of injury. The predictors with the highest odds ratio were used to develop the algorithm.
Among 9,227 patients meeting inclusion criteria, c-spine injury was identified in 553 patients (5.99%). All 553 patients had a c-spine fracture, and of these, 57 patients (0.6% of entire population and 10.31% of patients with injury) also had a ligamentous injury. No patient with a normal CT result was found to have an injury. The five greatest predictors of ligament injury that follow were used to develop the algorithm: (1) CT evidence of ligament injury; (2) fracture pattern "not" isolated transverse/spinous process; (3) neurologic symptoms; (4) midline tenderness; and (5) Glasgow Coma Scale score <15.
TTA patients should undergo screening c-spine CT to rule out injury. Most patients will have a negative CT and can have their collars removed. A select group of patients will require collars and spine consultation and a smaller subset of magnetic resonance imaging to rule out ligament injury.
Therapeutic study, level III.</description><identifier>ISSN: 2163-0755</identifier><identifier>EISSN: 2163-0763</identifier><identifier>DOI: 10.1097/TA.0000000000001151</identifier><identifier>PMID: 27270856</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Algorithms ; Cervical Vertebrae - diagnostic imaging ; Cervical Vertebrae - injuries ; Diagnosis, Differential ; Female ; Glasgow Coma Scale ; Humans ; Ligaments - injuries ; Magnetic Resonance Imaging ; Male ; Prospective Studies ; Spinal Injuries - diagnostic imaging ; Tomography, X-Ray Computed ; Trauma Centers ; Wounds, Nonpenetrating - diagnostic imaging</subject><ispartof>The journal of trauma and acute care surgery, 2016-09, Vol.81 (3), p.541-547</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c255t-1e45766db5d3ddfcde59e682bb96c5efdb3bb135458619c0ec23113f74b49b803</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27270856$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Duane, Therese M</creatorcontrib><creatorcontrib>Young, Andrew J</creatorcontrib><creatorcontrib>Vanguri, Poornima</creatorcontrib><creatorcontrib>Wolfe, Luke G</creatorcontrib><creatorcontrib>Katzen, Judith</creatorcontrib><creatorcontrib>Han, Jinfeng</creatorcontrib><creatorcontrib>Mayglothling, Julie</creatorcontrib><creatorcontrib>Whelan, James F</creatorcontrib><creatorcontrib>Aboutanos, Michel B</creatorcontrib><creatorcontrib>Ivatury, Rao R</creatorcontrib><creatorcontrib>Malhotra, Ajai K</creatorcontrib><title>Defining the cervical spine clearance algorithm: A single-institution prospective study of more than 9,000 patients</title><title>The journal of trauma and acute care surgery</title><addtitle>J Trauma Acute Care Surg</addtitle><description>Variability exists in the approach to cervical spine (c-spine) clearance after significant trauma. Using concurrently gathered data on more than 9,000 such patients, the current study develops an evidence-based and readily adoptable algorithm for c-spine clearance aimed at timely removal of collar, optimal use of imaging, and appropriate spine consultations.
Prospective study of adult blunt trauma team alert (TTA) patients presenting at a Level I trauma center who underwent screening computed tomography (CT) to diagnose/rule out c-spine injury (January 2008 to May 2014). Regression analysis comparing patients with and without c-spine injury-fracture and/or ligament-was used to identify significant predictors of injury. The predictors with the highest odds ratio were used to develop the algorithm.
Among 9,227 patients meeting inclusion criteria, c-spine injury was identified in 553 patients (5.99%). All 553 patients had a c-spine fracture, and of these, 57 patients (0.6% of entire population and 10.31% of patients with injury) also had a ligamentous injury. No patient with a normal CT result was found to have an injury. The five greatest predictors of ligament injury that follow were used to develop the algorithm: (1) CT evidence of ligament injury; (2) fracture pattern "not" isolated transverse/spinous process; (3) neurologic symptoms; (4) midline tenderness; and (5) Glasgow Coma Scale score <15.
TTA patients should undergo screening c-spine CT to rule out injury. Most patients will have a negative CT and can have their collars removed. A select group of patients will require collars and spine consultation and a smaller subset of magnetic resonance imaging to rule out ligament injury.
Therapeutic study, level III.</description><subject>Adult</subject><subject>Algorithms</subject><subject>Cervical Vertebrae - diagnostic imaging</subject><subject>Cervical Vertebrae - injuries</subject><subject>Diagnosis, Differential</subject><subject>Female</subject><subject>Glasgow Coma Scale</subject><subject>Humans</subject><subject>Ligaments - injuries</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Prospective Studies</subject><subject>Spinal Injuries - diagnostic imaging</subject><subject>Tomography, X-Ray Computed</subject><subject>Trauma Centers</subject><subject>Wounds, Nonpenetrating - diagnostic imaging</subject><issn>2163-0755</issn><issn>2163-0763</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUN1LwzAQD6K4MfcXCJJHH-xMmiZtfSvzEwa-zOeSpNct0qa1SQf7783YFPFe7g5-H3c_hK4pWVCSp_frYkH-FKWcnqFpTAWLSCrY-e_M-QTNnfs8oLjIGeeXaBKncUoyLqbIPUJtrLEb7LeANQw7o2WDXW9sWBuQg7QasGw23WD8tn3ABXYB3kBkrPPGj950FvdD53rQ3uwAOz9We9zVuO0GCLLS4vwuuONeegPWuyt0UcvGwfzUZ-jj-Wm9fI1W7y9vy2IV6ZhzH1FIeCpEpXjFqqrWFfAcRBYrlQvNoa4UU4oynvBM0FwT0DGjlNVpopJcZYTN0O1RN1z3NYLzZWuchqaRFrrRlTSjSdBjWR6g7AjV4RE3QF32g2nlsC8pKQ-Bl-ui_B94YN2cDEbVQvXL-YmXfQMkEHvq</recordid><startdate>201609</startdate><enddate>201609</enddate><creator>Duane, Therese M</creator><creator>Young, Andrew J</creator><creator>Vanguri, Poornima</creator><creator>Wolfe, Luke G</creator><creator>Katzen, Judith</creator><creator>Han, Jinfeng</creator><creator>Mayglothling, Julie</creator><creator>Whelan, James F</creator><creator>Aboutanos, Michel B</creator><creator>Ivatury, Rao R</creator><creator>Malhotra, Ajai K</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201609</creationdate><title>Defining the cervical spine clearance algorithm: A single-institution prospective study of more than 9,000 patients</title><author>Duane, Therese M ; Young, Andrew J ; Vanguri, Poornima ; Wolfe, Luke G ; Katzen, Judith ; Han, Jinfeng ; Mayglothling, Julie ; Whelan, James F ; Aboutanos, Michel B ; Ivatury, Rao R ; Malhotra, Ajai K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c255t-1e45766db5d3ddfcde59e682bb96c5efdb3bb135458619c0ec23113f74b49b803</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Algorithms</topic><topic>Cervical Vertebrae - diagnostic imaging</topic><topic>Cervical Vertebrae - injuries</topic><topic>Diagnosis, Differential</topic><topic>Female</topic><topic>Glasgow Coma Scale</topic><topic>Humans</topic><topic>Ligaments - injuries</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Prospective Studies</topic><topic>Spinal Injuries - diagnostic imaging</topic><topic>Tomography, X-Ray Computed</topic><topic>Trauma Centers</topic><topic>Wounds, Nonpenetrating - diagnostic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Duane, Therese M</creatorcontrib><creatorcontrib>Young, Andrew J</creatorcontrib><creatorcontrib>Vanguri, Poornima</creatorcontrib><creatorcontrib>Wolfe, Luke G</creatorcontrib><creatorcontrib>Katzen, Judith</creatorcontrib><creatorcontrib>Han, Jinfeng</creatorcontrib><creatorcontrib>Mayglothling, Julie</creatorcontrib><creatorcontrib>Whelan, James F</creatorcontrib><creatorcontrib>Aboutanos, Michel B</creatorcontrib><creatorcontrib>Ivatury, Rao R</creatorcontrib><creatorcontrib>Malhotra, Ajai K</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The journal of trauma and acute care surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Duane, Therese M</au><au>Young, Andrew J</au><au>Vanguri, Poornima</au><au>Wolfe, Luke G</au><au>Katzen, Judith</au><au>Han, Jinfeng</au><au>Mayglothling, Julie</au><au>Whelan, James F</au><au>Aboutanos, Michel B</au><au>Ivatury, Rao R</au><au>Malhotra, Ajai K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Defining the cervical spine clearance algorithm: A single-institution prospective study of more than 9,000 patients</atitle><jtitle>The journal of trauma and acute care surgery</jtitle><addtitle>J Trauma Acute Care Surg</addtitle><date>2016-09</date><risdate>2016</risdate><volume>81</volume><issue>3</issue><spage>541</spage><epage>547</epage><pages>541-547</pages><issn>2163-0755</issn><eissn>2163-0763</eissn><abstract>Variability exists in the approach to cervical spine (c-spine) clearance after significant trauma. Using concurrently gathered data on more than 9,000 such patients, the current study develops an evidence-based and readily adoptable algorithm for c-spine clearance aimed at timely removal of collar, optimal use of imaging, and appropriate spine consultations.
Prospective study of adult blunt trauma team alert (TTA) patients presenting at a Level I trauma center who underwent screening computed tomography (CT) to diagnose/rule out c-spine injury (January 2008 to May 2014). Regression analysis comparing patients with and without c-spine injury-fracture and/or ligament-was used to identify significant predictors of injury. The predictors with the highest odds ratio were used to develop the algorithm.
Among 9,227 patients meeting inclusion criteria, c-spine injury was identified in 553 patients (5.99%). All 553 patients had a c-spine fracture, and of these, 57 patients (0.6% of entire population and 10.31% of patients with injury) also had a ligamentous injury. No patient with a normal CT result was found to have an injury. The five greatest predictors of ligament injury that follow were used to develop the algorithm: (1) CT evidence of ligament injury; (2) fracture pattern "not" isolated transverse/spinous process; (3) neurologic symptoms; (4) midline tenderness; and (5) Glasgow Coma Scale score <15.
TTA patients should undergo screening c-spine CT to rule out injury. Most patients will have a negative CT and can have their collars removed. A select group of patients will require collars and spine consultation and a smaller subset of magnetic resonance imaging to rule out ligament injury.
Therapeutic study, level III.</abstract><cop>United States</cop><pmid>27270856</pmid><doi>10.1097/TA.0000000000001151</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Algorithms Cervical Vertebrae - diagnostic imaging Cervical Vertebrae - injuries Diagnosis, Differential Female Glasgow Coma Scale Humans Ligaments - injuries Magnetic Resonance Imaging Male Prospective Studies Spinal Injuries - diagnostic imaging Tomography, X-Ray Computed Trauma Centers Wounds, Nonpenetrating - diagnostic imaging |
| title | Defining the cervical spine clearance algorithm: A single-institution prospective study of more than 9,000 patients |
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