Clearing the cervical spine after polytrauma: implementing unified management for unconscious victims in the intensive care unit

• Published in: Anaesthesia 2004-08, Vol.59 (8), p.755-761
• Main Authors: Morris, C. G., Mullan, B.
• Format: Article
• Language: English
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - injuries; Critical Care - methods; Critical Care - standards; Diagnostic imaging; Fluoroscopy; Guidelines; Health Care Surveys; Humans; Immobilization; Intubation, Intratracheal; Magnetic Resonance Imaging; Medical sciences; Multiple Trauma - diagnostic imaging; Patient Care Team; Practice Guidelines as Topic; Radionuclide Imaging; Risk Factors; Spinal injuries; Surveys and Questionnaires; Tomography, X-Ray Computed; Unconsciousness - diagnostic imaging; Unconsciousness - etiology
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/j.1365-2044.2004.03743.x

Summary Determining the best method for excluding cervical spine injury while a polytrauma victim is unconscious remains a controversial topic despite a number of published guidelines. A structured questionnaire demonstrated major differences between intensivists, neurosurgeons, orthopaedic surgeons and spinal surgeons with regard to the imaging modalities requested, the perception of their performance, the relative risks of missed injuries and the complications of immobilisation. Unconscious victims of polytrauma often come under the care of several subspecialties, with the direct consequence that management can be contradictory and lack standardisation. Advanced Trauma Life Support and Eastern Association for the Surgery of Trauma guidelines can reinforce and even contribute to non‐standardised care. Having performed this clinician survey, we have now developed a multidisciplinary management protocol appropriate for Northern Ireland.