A Proposal for a Best-Practice Protocol for the Management of Patients with Suspected Cervical Spine Injury

Abstract

Background: Research suggests that cervical spine CT examination is over used for potential injury due to blunt trauma. Education of emergency providers regarding evidence-based guidelines can help reduce the over-use of CT examination, and the development of an evidence-based protocol for the management of patients with suspected cervical spine trauma may help promote more appropriate clinical use of radiologic imaging for cervical spine clearance. Purpose: The ultimate goal of this project is to develop a best-practice, evidence-based protocol for the management of patients with suspected cervical spine injury, in order to promote safe and efficient clinical clearance, as well as promote judicious and appropriate use of diagnostic imaging for suspected cervical spine injury. Methods: A retrospective chart review of emergency radiographic imaging studies obtained over a three-month timeframe for suspected cervical spine injury at a 300-bed hospital in Tucson, Arizona was performed to compare ordering practices with the ACR-AC. Descriptive statistics were used for data analysis. A web-based survey was conducted of facility stakeholders including emergency physicians, nurse practitioners and physician assistants regarding their views about clinical guidelines and protocols for radiographic and clinical clearance of cervical spine injury. Descriptive statistics and thematic analysis was used for survey responses. Results: Analysis of 263 imaging studies over a three-month timeframe demonstrated that 24.3% of cervical spine imaging studies obtained in three-month timeframe would be considered not appropriate based on the ACR-AC. The survey of emergency clinicians revealed that none of those who responded have a preference for referring to the ACR appropriateness criteria, and the majority of respondents did not support the implementation of a hospital protocol for the management of patients with suspected cervical spine trauma. Recommendations: An institutional protocol for suspected cervical spine injury developed from the ACR-AC with incorporation of clinical clearance criteria is recommended. To promote clinician acceptance, overcome resistance to implementation, and promote individualized patient care, the protocol should also include provider education and should allow for variance based on individual patient circumstances.