• Abid D Khan, Sean C Liebscher, Hannah C Reiser, Thomas J Schroeppel, Michael J Anstadt, Patrick L Bosarge, Shannon L Carroll, Jacob A Quick, Stephen L Barnes, Justin Sobrino, Jason Murry, Nicholas Morin, Mario Gomez, Heitor Consani, and Richard P Gonzalez.
• From the Division of Trauma and Acute Care Surgery, Department of Surgery (A.D.K., S.C.L., H.C.R., M.J.A., R.P.G.), Loyola University Medical Center, Maywood, Illinois; Department of Trauma and Acute Care Surgery (A.D.K., T.J.S.), University of Colorado Health-Memorial Hospital, Colorado Springs, Colorado; Division of Acute Care Surgery (P.L.B.S.L.C.), University of Alabama at Birmingham, Birmingham, Alabama; Division of Acute Care Surgery (J.A.Q., S.L.B.), University of Missouri, Columbia, Missouri; Department of Surgery (J.S.), University of South Alabama Medical Center, Mobile, Alabama; University of Texas Health-Tyler (J.M.), Tyler, Texas; Department of Surgery (N.M., M.G.), New York University Langone Hospital-Brooklyn, New York, New York; and Conjunto Hospitalar de Sorocaba (H.C.), Sorocaba, Brazil.
• J Trauma Acute Care Surg. 2019 Jan 1; 86 (1): 28-35.

BackgroundSingle institution studies have shown that clinical examination of the cervical spine (c-spine) is sensitive for clearance of the c-spine in blunt trauma patients with distracting injuries. Despite an unclear definition, most trauma centers still adhere to the notion that distracting injuries adversely affect the sensitivity of c-spine clinical examination. A prospective AAST multi-institutional trial was performed to assess the sensitivity of clinical examination screening of the c-spine in awake and alert blunt trauma patients with distracting injuries.MethodsDuring the 42-month study period, blunt trauma patients 18 years and older were prospectively evaluated with a standard c-spine examination protocol at 8 Level 1 trauma centers. Clinical examination was performed regardless of the presence of distracting injuries. Patients without complaints of neck pain, tenderness or pain on range of motion were considered to have a negative c-spine clinical examination. All patients with positive or negative c-spine clinical examination underwent computed tomography (CT) scan of the entire c-spine. Clinical examination findings were documented prior to the CT scan.ResultsDuring the study period, 2929 patients were entered. At least one distracting injury was diagnosed in 70% of the patients. A c-spine injury was found on CT scan in 7.6% of the patients. There was no difference in the rate of missed injury when comparing patients with a distracting injury to those without a distracting injury (10.4% vs. 12.6%, p = 0.601). Only one injury missed by clinical examination underwent surgical intervention and none had a neurological complication.ConclusionsNegative clinical examination may be sufficient to clear the cervical spine in awake and alert blunt trauma patients, even in the presence of a distracting injury. These findings suggest a potential source for improvement in resource utilization.Level Of EvidenceTherapeutic/care management, level IV.

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