Computed tomography for early and safe discontinuation of cervical spine immobilization in obtunded multiply injured patients

J Trauma. 2007 Sep;63(3):630-6. doi: 10.1097/TA.0b013e318076b537.


Background: Evaluation of the cervical spine (c-spine) in obtunded severely injured trauma patients is controversial, and spine immobilization is frequently prolonged. We examined the effect of two different c-spine evaluation protocols on c-spine immobilization and clinical outcomes.

Methods: We prospectively evaluated consecutive intubated and mechanically ventilated patients admitted to the surgical intensive care unit (ICU) of a Level I academic trauma center with a diagnosis of multiple blunt injuries who had normal findings on high-resolution helical computed tomogram of C1 to T1 with reconstructions (HCTrecon). From July 1, 2003 to June 30, 2005 (n = 140), the findings of HCTrecon and either clinical examination or magnetic resonance imaging (MRI) were required to be normal to discontinue c-spine immobilization (clinical/MRI protocol). From July 1, 2005 to June 30, 2006 (n = 75), the policy was changed to require normal finding only on HCTrecon to discontinue c-spine immobilization (HCTrecon protocol).

Results: Patients evaluated by the clinical/MRI and HCTrecon protocols had similar baseline characteristics. Compared with clinical/MRI patients, HCTrecon patients had their c-spines immobilized for fewer days (median, 6 days vs. 2 days; p < 0.001), were less likely to experience a complication of c-spine immobilization (64% vs. 37%, p = 0.010), required shorter periods of mechanical ventilation (median, 4 days vs. 3 days; p = 0.011), and had shorter stays in the ICU (median, 6 days vs. 4 days; p = 0.028) and hospital (median, 16 days vs. 14 days; p = 0.043). There was no difference in hospital mortality (13% vs. 16%, p = 0.920) and no missed c-spine injuries in either group.

Conclusion: Discontinuation of c-spine precautions based on the normal findings of HCTrecon decreases the duration of c-spine immobilization in obtunded severely injured patients and is associated with fewer complications, fewer days of mechanical ventilation, and shorter stays in the ICU and hospital.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Cervical Vertebrae / diagnostic imaging*
  • Cervical Vertebrae / injuries*
  • Chi-Square Distribution
  • Female
  • Humans
  • Immobilization*
  • Injury Severity Score
  • Intubation, Intratracheal
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Multiple Trauma / diagnostic imaging
  • Neck Injuries / diagnostic imaging*
  • Prospective Studies
  • Statistics, Nonparametric
  • Tomography, X-Ray Computed*
  • Wounds, Nonpenetrating / diagnostic imaging