General Surgery Department, Hamad General Hospital, HMC, Doha, Qatar.
Trauma Surgery Department, Hamad General Hospital, HMC, Doha, Qatar.
J Intensive Care Med. 2023 Oct;38(10):903-910. doi: 10.1177/08850666231194529. Epub 2023 Aug 15.
Cervical spine clearance in intubated patients due to blunt trauma remains contentious. Accumulating evidence suggests that a normal computed tomography (CT) cervical spine can be used to clear the cervical spine and remove the collar in unconscious patients presenting to the emergency department. However, whether this strategy can safely be employed by critical care physicians with intubated patients admitted to the trauma intensive care unit (TICU) with cervical collars in situ, has not been definitively studied. A retrospective review of 730 intubated victims of trauma who presented to the Level 1 Trauma center of a tertiary hospital was conducted. The rates of missed cervical injuries in patients who had their cervical collars removed by intensive care physicians based on a normal CT scan of the cervical spine, were reviewed. Secondary outcomes included rates of collar-related complications. Three hundred and fifty patients had their cervical collars removed by Trauma ICU doctors based on a high-quality, radiologist-interpreted normal CT cervical spine. Seventy percent of patients were sedated and/or comatose at the time of collar removal. Fifty-one percent of patients had concomitant traumatic brain injury. The average GCS at time of collar removal was 9. The incidence of missed neurological injury discerned clinically at time of both ICU and hospital discharge was nil (negative predictive value 100%). The rate of collar-related complications was 2%. Cervical collar removal by intensive care physicians on TICU following normal CT cervical spine, is safe, provided certain quality conditions related to the CT scan are met. Not removing the collar early may be associated with increased complications. An algorithm is suggested to assist critical care decision-making in this patient cohort.
颈椎间隙在因钝器伤而插管的患者中仍然存在争议。越来越多的证据表明，在无意识的患者中，正常的计算机断层扫描（CT）颈椎可以用于清除颈椎并去除颈托。然而，这种策略是否可以由重症监护医生安全地应用于创伤重症监护病房（TICU）中带有颈托的插管患者，尚未得到明确研究。对一家三级医院的 1 级创伤中心的 730 例创伤性插管患者进行了回顾性研究。回顾了根据颈椎 CT 正常扫描，由重症监护医生去除颈托的患者中颈椎损伤漏诊的发生率。次要结局包括颈托相关并发症的发生率。350 例患者由创伤 ICU 医生根据高质量、放射科医生解读的正常 CT 颈椎去除颈托。70%的患者在去除颈托时处于镇静和/或昏迷状态。51%的患者伴有创伤性脑损伤。去除颈托时的平均 GCS 为 9 分。在 ICU 和出院时临床发现的神经损伤漏诊发生率为零（阴性预测值 100%）。颈托相关并发症的发生率为 2%。在满足与 CT 扫描相关的某些质量条件的情况下，TICU 的重症监护医生通过正常 CT 颈椎去除颈托是安全的。不早期去除颈托可能与并发症增加有关。建议提出一种算法来协助该患者人群的重症监护决策。
