Cervical Spine Clearance in Trauma Patients

Original Date: 02/2009 | Supersedes: 09/2002, 05/2014, 06/2021 | Last Review Date: 04/2024
Purpose: To identify a method of clearing the cervical spine in the obtunded trauma patient to prevent decubitus ulcers AND not miss any clinically significant injuries.

The C collar can be removed in the unconscious or obtunded patients once the following criteria have been met:

  • The attending radiologist has dictated a final report of the CT scan of the cervical spine
  • This final report has no cervical spine fracture or acute abnormality
  • A tertiary survey has been completed and documented

The C collar should remain in place and the spine service consulted if ANY of the following criteria are present:

  • Any signs of focal neurologic deficit on physical exam
  • Any acute abnormal findings on CT scan of the cervical spine
  • Please change to Miami J collar within 12 hours

References

  1. Hennessy D, Widder S, Zygun D, Hurlbert RJ, Burrowes P, Kortbeek JB. Cervical spine clearance in obtunded blunt trauma patients: a prospective study. J Trauma. 2010;68(3):576–582. doi:10.1097/TA.0b013e3181cf7e55.
  2. Raza M, Elkhodair S, Zaheer A, Yousaf S. Safe cervical spine clearance in adult obtunded blunt trauma patients on the basis of a normal multidetector CT scan–a meta-analysis and cohort study. Injury. 2013;44(11):1589–1595. doi:10.1016/j.injury.2013.06.005.
  3. Ackland H, Cooper J, Malham G, Kossmann T. Factors predicting cervical collar-related decubitus ulceration in major trauma patients.  Spine. 2007;32(4): 423-428.