Spine Clearance Research Articles

Current practice in clinical cervical spinal clearance: Implication for ems

Objectives. To examine the practice of clinically “clearing” the cervical spine (c-spine) of trauma patients brought to the ED by EMS with cervical immobilization in place, and to examine developing trends in prehospital c-spine clearance. Methods. A 12-question survey form was mailed to the physician medical directors of 300 randomly selected EDs. Questions examined ED clinical clearance practices, EMS clearance protocols and research, and attitudes toward prehospital clearance. Estimated clinical clearance rates were requested. Results. A total of 173 surveys were returned (58%). At 21 hospitals (12%), c-spine films are obtained for all immobilized trauma patients; clinical clearance is never attempted. Of the remaining 151 hospitals, on average, clinical clearance is attempted for 65.5% of these patients (range 3–100%, interquartile range 50–100%) and is successful (films are not obtained) for 53.7% of attempts (range 0–100%, interquartile range 35–75%). No differences exist in either attempt rate or success rate between trauma centers and non-trauma centers, or between academic/university hospitals, community teaching hospitals, and community non-teaching hospitals (t-test or ANOVA, p > 0.05). Seventy-two respondents (42%) reported significant variation in clinical clearance practice patterns among their ED physicians. Seventy-three respondents (42%) feel that EMS providers should immobilize all trauma patients, while 99 (57%) feel it is reasonable for trained EMS providers to attempt clinical clearance on low-risk trauma patients. Conclusions. There is tremendous variation in the ED practice of clinically clearing cervical spines. This, and a lack of support from many ED directors, may hinder attempts at development of research and standardized protocols for prehospital c-spine clearance.

Spine clearance--a trauma center's standardized approach to assist care givers.

Spine clearance is a high-volume, high-risk issue for trauma centers. Spinal cord injuries can be one of the most devastating injuries a person can incur. The initial treatment regimen can affect the occurrence of permanent injury. Pre-hospital providers take great pains to immobilize the spine. This article describes an approach adopted by a Level I trauma center to manage admitted patients where a spinal column or ligamentous injury has not been determined.

Effects of pressure on cerebrospinal fluid formation: nonsteady-state measurements in dogs.

Effects of pressure on cerebrospinal fluid (CSF) formation were studied in dogs with a recirculatory spinal perfusion tracer clearance technique that does not require steady-state conditions. The data permit statistical analysis of the relationship between the rate of CSF formation and pressure for individual animals. Most animals showed no statistical relationship between CSF formation and intracranial pressure (ICP) and/or cerebral perfusion pressure (CPP). In this study, a disturbance of cerebral blood flow (CBF) autoregulation may have been present in five animals on the basis of CPP reductions, and four of this latter group showed formation to decrease with increasing ICP. It is suggested that CSF formation is normally pressure insensitive. With impaired autoregulation of CBF, formation may follow CBF and CPP passively.