Discontinuation of cervical spine immobilisation in unconscious patients with trauma in intensive care units telephone survey of practice in South and West region

Abstract Objective: To study how the cervical spine is assessed before discontinuation of cervical spine immobilisation in unconscious trauma patients in intensive care units. Design: Telephone interview of consultants responsible for adult intensive care units. Setting: All 25 intensive care units in the South and West region that admit victims of major trauma. Main outcome measures: The clinical and radiological basis on which the decision is made to stop cervical spine immobilisation in unconscious patients with trauma. Results: In 19 units cervical spine immobilisation was stopped in unconscious patients on the basis of radiology alone, and six units combined radiology with clinical examination after the patient had regained consciousness. Sixteen units relied on a normal lateral radiological view of the cervical spine alone, five required a normal lateral and anteroposterior view, and four required a normal lateral, anteroposterior, and open mouth peg view. Conclusions: There are inconsistencies in the clinical and radiological approach to assessing the cervical spine in unconscious patients with trauma before the removal of immobilisation precautions. There is an overreliance on the lateral cervical spine view alone, which has been shown to be insensitive in this setting. Key messages Immobilisation of the cervical spine is essential in victims of major trauma until the cervical spine is fully assessed for injury In the NHS region surveyed intensive care units show little consistency in how the cervical spine is assessed before the removal of immobilisation precautions Most practitioners would be prepared to accept radiography of the lateral cervical spine as the sole radiological assessment, although it has been shown to be an insensitive screening tool Computed tomography targeted at poorly visualised or suspicious areas in three plain radiographs (lateral, anteroposterior, and open mouth peg views) is a sensitive technique for the radiological detection of injury to the bony cervical spine