The Use of Clinical Cervical Spine Clearance in Trauma Patients: A Literature Review

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Introduction:Five million patients in America are placed in spinal immobilization annually, with only 1% to 2% of these patients suffering from an unstable cervical spine injury. Prehospital agencies are employing selective and limited immobilization practices, but there is concern that this practice misses cervical spine injuries and therefore possibly predisposes patients to worsening injuries.Methods:A systematic review was conducted that examined literature from the last 5 years that reviewed cervical spine immobilization application and/or clearance in alert trauma patients.Results:Prehospital selective immobilization protocols and bedside clinical clearance examinations are becoming more commonplace, with few missed injuries or poor outcomes. Prehospital providers can evaluate patients in the field safely to assess who needs or does not need cervical collars; similar criteria can be used in the emergency department. Harm from cervical collars is increasingly documented, with concerns that risks exceed possible benefits.Discussion:The literature suggests that alert trauma patients can be cleared from cervical spine immobilization safely through a structured algorithm in either the prehospital or ED setting. The evidence is primarily observational. Thus, many providers who fear missing cervical injuries may be reluctant to follow the recommendations despite few or no published cases of sudden deterioration from missed cervical spine injuries.Contribution to Emergency Nursing Practice:This manuscript adds to emergency nursing knowledge by discussing the risks of cervical collars and the latest evidence regarding clinical clearance of cervical spine immobilization precautions in trauma patients.With this evidence, the use of cervical collars can be decreased, and only those patients who cannot be clinically cleared will need to be immobilized. This will reduce needless routine spinal immobilization of all trauma patients.

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