Assessing the Implementation of Guidelines for the Management of the Potentially Injured Cervical Spine in Unconscious Trauma Patients in England

BACKGROUND:There are many complications involved in the immobilization of unconscious patients with potential cervical spine injuries. In February 2005, the Intensive Care Society (ICS), United Kingdom, produced consensus guidelines to evaluate spinal injuries in unconscious victims of blunt multiple injuries to address this important clinical problem. METHODS:A postal questionnaire was sent to lead consultants of intensive care units in England enquiring about the management of the cervical spine in unconscious trauma patients. Data were collated, and the responses to open questions were grouped into themes. Responses were compared with published ICS guidelines. RESULTS:The response rate was 46% (91 of 199). Forty-four of 89 units had formal policies. Twenty-two of 44 of these units had adopted national guidelines. Common methods of immobilization were “collar & head blocks” (59 of 83) and collar only (18 of 83). Thirty of the 70 were immobilized in a semirigid collar. Common X-ray combinations were combined lateral/anteroposterior/Odontoid views (18 of 64) and lateral and anteroposterior views (21 of 64). Fifty of 71 would perform computed tomography scans if images were unsatisfactory. Senior radiologist involvement in reporting was mentioned by 65 of 78. Immobilization was discontinued in the presence of normal X-ray studies and computed tomography scans by 44 of 83. CONCLUSION:A unit policy ensures that current recommendations are followed. Despite the ICS guidelines being published 4 years ago, over half of the individual intensive care units have no policy in place. A lack of adequate guidance for junior doctors can lead to steps in the process of clearance being omitted and potential injuries being missed. We recommend that the national organization do more to facilitate a wider dissemination of these guidelines.