Aim. Identifying cervical spine injuries in confused or comatose patients
with multiple injuries provides a diagnostic challenge. Our aim
was to investigate the protocols which are used for the clearance
of the cervical spine in these patients in English hospitals. Patients and Methods. All hospitals in England with an Emergency Department were asked
about the protocols which they use for assessing the cervical spine.
All 22 Major Trauma Centres (MTCs) and 141 of 156 non-MTCs responded
(response rate 91.5%). Results. Written guidelines were used in 138 hospitals (85%). CT scanning
was the first-line investigation in 122 (75%). A normal CT scan
was sufficient to clear the cervical spine in 73 (45%). However,
40 (25%) would continue precautions until the patient regained full
consciousness. MRI was performed in all confused or comatose patients
with a possible cervical spinal injury in 15 (9%). There were variations
in the grade and speciality of the clinician who had responsibility
for deciding when to discontinue precautions. A total of 31 (19%)
reported at least one missed cervical spinal injury following discontinuation
of spinal precautions within the last five years. Only 93 (57%)
had a formal mechanism for reviewing missed injuries. Take home message: There are significant variations in protocols
and practices for the clearance of the cervical spine in multiply
injured patients in acute hospitals in England. The establishment
of
This study examined spinal fractures in patients
admitted to a Major Trauma Centre via two independent pathways,
a major trauma (MT) pathway and a standard unscheduled non-major
trauma (NMT) pathway. A total of 134 patients were admitted with
a spinal fracture over a period of two years; 50% of patients were
MT and the remainder NMT. MT patients were predominantly male, had
a mean age of 48.8 years (13 to 95), commonly underwent surgery
(62.7%), characteristically had fractures in the cervico-thoracic
and thoracic regions and 50% had fractures of more than one vertebrae,
which were radiologically unstable in 70%. By contrast, NMT patients
showed an equal gender distribution, were older (mean 58.1 years;
12 to 94), required fewer operations (56.7%), characteristically
had fractures in the lumbar region and had fewer multiple and unstable
fractures. This level of complexity was reflected in the length
of stay in hospital; MT patients receiving surgery were in hospital
for a mean of three to four days longer than NMT patients. These
results show that MT patients differ from their NMT counterparts
and have an increasing complexity of spinal injury. Cite this article:
