Prospective evaluation of a critical care pathway for clearance of the cervical spine using the bolster and active range-of-motion flexion/extension techniques

Johnathan M. Mauldin, Robert Maxwell, Stephen M. King, Robert F. Phlegar, Michael R. Gallagher, Donald E. Barker, R. Phillip Burns

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND: Clearance of the cervical spine after blunt trauma remains controversial in patients with normal radiologic evaluation. METHODS: Blunt trauma patients with midline boney cervical tenderness and plain films that disclose no abnormalities and computed tomography (CT) scans were entered into a care pathway for spinal clearance using the Bolster or active range-of-motion (AROM) flexion/extension techniques. The quality of films between the two techniques was then compared. RESULTS: In all, 159 patients entered the pathway with 14 patients (9%) unable to complete the examination secondary to pain. The Bolster was used in 129 patients (89%) and AROM was used in 16 (11%). The total range of motion was significantly better with AROM at 51.4 ± 19.4 degrees of motion compared with 32.0 ± 13.0 degrees with the Bolster (p ≤ 0.05). The most distal level visualized was not different between groups with 6.6 ± 0.8 cervical vertebrae visualized on average in the Bolster group and 6.8 ± 0.7 in the AROM group. Positive findings occurred in five patients (3.4%) in the Bolster group. CONCLUSION: The incidence of occult cervical injury in patients with boney cervical pain despite normal plain films and CT scans in this study was 3.4%. The AROM technique has better total range of motion than the Bolster, although results of the Bolster technique remain within acceptable standards. The present care pathway appears to be an effective screening tool for evaluation of this population of patients. Additional evaluation of the obtunded patient is necessary before broad implementation of this technique.

Original languageEnglish (US)
Pages (from-to)679-685
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume61
Issue number3
DOIs
StatePublished - Sep 1 2006
Externally publishedYes

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Critical Pathways
Critical Care
Articular Range of Motion
Spine
Motion Pictures
Wounds and Injuries
Tomography
Cervical Vertebrae
Neck Pain
Pain
Incidence

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Prospective evaluation of a critical care pathway for clearance of the cervical spine using the bolster and active range-of-motion flexion/extension techniques. / Mauldin, Johnathan M.; Maxwell, Robert; King, Stephen M.; Phlegar, Robert F.; Gallagher, Michael R.; Barker, Donald E.; Burns, R. Phillip.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 61, No. 3, 01.09.2006, p. 679-685.

Research output: Contribution to journalArticle

Mauldin, Johnathan M. ; Maxwell, Robert ; King, Stephen M. ; Phlegar, Robert F. ; Gallagher, Michael R. ; Barker, Donald E. ; Burns, R. Phillip. / Prospective evaluation of a critical care pathway for clearance of the cervical spine using the bolster and active range-of-motion flexion/extension techniques. In: Journal of Trauma - Injury, Infection and Critical Care. 2006 ; Vol. 61, No. 3. pp. 679-685.
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abstract = "BACKGROUND: Clearance of the cervical spine after blunt trauma remains controversial in patients with normal radiologic evaluation. METHODS: Blunt trauma patients with midline boney cervical tenderness and plain films that disclose no abnormalities and computed tomography (CT) scans were entered into a care pathway for spinal clearance using the Bolster or active range-of-motion (AROM) flexion/extension techniques. The quality of films between the two techniques was then compared. RESULTS: In all, 159 patients entered the pathway with 14 patients (9{\%}) unable to complete the examination secondary to pain. The Bolster was used in 129 patients (89{\%}) and AROM was used in 16 (11{\%}). The total range of motion was significantly better with AROM at 51.4 ± 19.4 degrees of motion compared with 32.0 ± 13.0 degrees with the Bolster (p ≤ 0.05). The most distal level visualized was not different between groups with 6.6 ± 0.8 cervical vertebrae visualized on average in the Bolster group and 6.8 ± 0.7 in the AROM group. Positive findings occurred in five patients (3.4{\%}) in the Bolster group. CONCLUSION: The incidence of occult cervical injury in patients with boney cervical pain despite normal plain films and CT scans in this study was 3.4{\%}. The AROM technique has better total range of motion than the Bolster, although results of the Bolster technique remain within acceptable standards. The present care pathway appears to be an effective screening tool for evaluation of this population of patients. Additional evaluation of the obtunded patient is necessary before broad implementation of this technique.",
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AU - Gallagher, Michael R.

AU - Barker, Donald E.

AU - Burns, R. Phillip

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N2 - BACKGROUND: Clearance of the cervical spine after blunt trauma remains controversial in patients with normal radiologic evaluation. METHODS: Blunt trauma patients with midline boney cervical tenderness and plain films that disclose no abnormalities and computed tomography (CT) scans were entered into a care pathway for spinal clearance using the Bolster or active range-of-motion (AROM) flexion/extension techniques. The quality of films between the two techniques was then compared. RESULTS: In all, 159 patients entered the pathway with 14 patients (9%) unable to complete the examination secondary to pain. The Bolster was used in 129 patients (89%) and AROM was used in 16 (11%). The total range of motion was significantly better with AROM at 51.4 ± 19.4 degrees of motion compared with 32.0 ± 13.0 degrees with the Bolster (p ≤ 0.05). The most distal level visualized was not different between groups with 6.6 ± 0.8 cervical vertebrae visualized on average in the Bolster group and 6.8 ± 0.7 in the AROM group. Positive findings occurred in five patients (3.4%) in the Bolster group. CONCLUSION: The incidence of occult cervical injury in patients with boney cervical pain despite normal plain films and CT scans in this study was 3.4%. The AROM technique has better total range of motion than the Bolster, although results of the Bolster technique remain within acceptable standards. The present care pathway appears to be an effective screening tool for evaluation of this population of patients. Additional evaluation of the obtunded patient is necessary before broad implementation of this technique.

AB - BACKGROUND: Clearance of the cervical spine after blunt trauma remains controversial in patients with normal radiologic evaluation. METHODS: Blunt trauma patients with midline boney cervical tenderness and plain films that disclose no abnormalities and computed tomography (CT) scans were entered into a care pathway for spinal clearance using the Bolster or active range-of-motion (AROM) flexion/extension techniques. The quality of films between the two techniques was then compared. RESULTS: In all, 159 patients entered the pathway with 14 patients (9%) unable to complete the examination secondary to pain. The Bolster was used in 129 patients (89%) and AROM was used in 16 (11%). The total range of motion was significantly better with AROM at 51.4 ± 19.4 degrees of motion compared with 32.0 ± 13.0 degrees with the Bolster (p ≤ 0.05). The most distal level visualized was not different between groups with 6.6 ± 0.8 cervical vertebrae visualized on average in the Bolster group and 6.8 ± 0.7 in the AROM group. Positive findings occurred in five patients (3.4%) in the Bolster group. CONCLUSION: The incidence of occult cervical injury in patients with boney cervical pain despite normal plain films and CT scans in this study was 3.4%. The AROM technique has better total range of motion than the Bolster, although results of the Bolster technique remain within acceptable standards. The present care pathway appears to be an effective screening tool for evaluation of this population of patients. Additional evaluation of the obtunded patient is necessary before broad implementation of this technique.

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