Most California trauma centers follow standardized cervical spine clearance protocols

SAN FRANCISCO — Written cervical spine clearance protocols are used in the majority of California’s trauma centers, according to data presented here at the North American Spine Society Annual Meeting.

“We need to encourage the use of standardized protocols based on the latest medical evidence to encourage better patient care,” Murat Pekmezci, MD, said.

In the observational, cross-sectional study, Pekmezci and colleagues tested the lack of consistency in cervical spine clearance protocols in 25 level-1 trauma centers, 30 level-2 trauma centers and 11 level-3 trauma centers in California. They reviewed the protocol used for clearing asymptomatic patients, initial imaging modalities used in patients who did not have medical clearance, management strategies for patients who had persistent neck pain and negative CT scans, and patients who were obtunded.

Murat Pekmezci

Outcome measures included self-reported outcomes of the trauma centers’ cervical spine clearance protocols. The researchers compared the results with the most recent Eastern Association for the Surgery of Trauma (EAST) cervical spine clearance protocols.

Pekmezci and colleagues found 63% of the trauma centers surveyed used written cervical spine clearance protocols, with only half of the protocols being up-to date. For asymptomatic patients, 83% of the level-1 centers and 61% of the level-2 centers used the National Emergency C-Radiography Study criteria for patients who did and did not have painless range-of-motion issues. For patients who required imaging, they found physicians at 67% of level 1 and 56% of the level-2 centers used a CT scan as the first line of imaging.

“Level-1 centers in California corresponded reasonably well compared with the other level-1 centers across the nation. Unfortunately, level-2 centers are falling a little behind,” Pekmezci said.

The researchers found that more than 90% of level-1 trauma centers and more than 70% of level-2 trauma centers used the EAST recommendations for obtunded patients and patients who had persistent neck pain and negative CT scans. — by Kristine Houck, MA, ELS

Reference:

Pekmezci M. Cervical spine clearance protocols in level I, II and III trauma centers in California. Presented at: North American Spine Society Annual Meeting. Nov. 12-15, 2014; San Francisco.

Disclosure: Pekmezci has no relevant financial disclosures.