Time Factor and Value Assessment of Cervical Spine X-rays in Major Trauma Patients in the Resuscitation Suite
Updated: Sep 11
Author: Cordone M, O'Connell M, Pineau M, Bandanza D; Atweh, N, Bradley K
Abstract presented at the American College of Emergency Physicians Research Forum, Oct 2001
Purpose: To determine the time delays incurred and the value added for cervical spine x-rays taken during the 1st hour of major trauma resuscitations.
Methods: Design prospective, observational Setting Level 1 trauma center Inclusion criteria While a Research Associate (RA) was on duty, all major trauma patients (Code > Alert) were included. Exclusion criteria None. Procedure The RA used a stopwatch to record the elapsed time from arrival to various radiologic studies, procedures, patient movements and outcomes. After cervical spine x-rays were returned, the RA also asked the Trauma Team Leader if repeat studies were being taken and if the C7-T1 junction was visible on the lateral film.
Results: 99 subjects were enrolled. 25 (25%) were Trauma Codes. 89 (90%) were collared on arrival and 10 (10%) were not. 4 (4%), all Alerts, were clinically cleared. 85 subjects were collared at the end of the secondary survey and were included in analysis. 62 (73%) had cervical spine films in the Resuscitation Suite at a mean time from arrival of 17 minutes and mean time to viewing by the Trauma Team Leader of 34 minutes. The remainder had a cervical CT without initial cervical spine x-rays. The C7-T1 junction could not be seen on 30 (48%) of the initial lateral views. Of these, 70% had additional plain radiographs, 30% had cervical spine CT as the next study. 41% of those who had additional plain radiographs went on to cervical CT. 50 (81%) subjects evaluated with cervical spine films in the Resuscitation Suite had them performed before a chest x-ray, but with an average delay to performance of only 3.5 minutes. Of the 85 subjects collared at the end of the secondary survey, only 15 (18%) had their collars removed within the first hour of care (mean time to removal within the first hour = 34 min).
Conclusion: Cervical spine radiographs in the Resuscitation Suite are of limited value in cervical spine clearance, but have only a minimal impact on time factors for trauma resuscitations.
